NAFLD and NASH Occurring After Liver Transplantation: A Review

Recurrence of NASH/NAFLD after liver transplantation requires attention. Factors include weight gain, post-transplant diabetes, and immunosuppressant drugs. Donor-related genetic risk factors also contribute. A multidisciplinary approach is essential for prevention and management.
PUBLISHED IN: Nat Rev Endocrinol 2023

Survival rates of patients who receive a liver transplant for NASH-related cirrhosis are generally good, being found to be similar to that of any other liver transplant cause. However, these patients face a high risk of waiting-list mortality, cardio-metabolic complications as well as recurrent or de novo NAFLD after the transplantation.

Immunosuppressant drugs often exacerbate the possible cardio-metabolic issues after transplantation, so careful management of these as well as treatment of existing complications is necessary. The issues with recurrent NASH/NAFLD are a vital focus: up to 55% of cases of NASH post-transplantation were recurrent, and up to 20% were de novo.

Currently, it is not known whether such patients may require a second transplant. Predictors of this recurrent/new development of NASH include weight gain, post-transplantation diabetes mellitus or immunosuppressant drugs.

Donor-related risk factors such as PNPLA3 and TM6SF2 genetic variants can produce risk too. Effective interventions for this group are vital. One important factor is weight loss: for every 5kg of weight lost by an individual with NAFLD, around a 5% reduction in steatosis is found.

This review by Lonardo A et al. aimed to the reasons behind and interventions for NASH reoccurring after liver transplantation.

Key learnings

Strategies for the prevention and management of NAFLD and NASH after liver transplantation are vital to be implemented clinically. This should involve an individualised, multidisciplinary approach involving optimizing the treatment of cardiometabolic comorbidities, weight loss and management of medication use.

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Z. Beketova

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