Liver Transplantation for Nonalcoholic Steatohepatitis: Pathophysiology of Recurrence and Clinical Challenges.
Naga Swetha SamjiRajanshu VermaKrishna Chaitanya KeriAshwani K SingalAijaz AhmedMary RinellaDavid BernsteinManal F AbdelmalekSanjaya Kumar SatapathyPublished in: Digestive diseases and sciences (2019)
Nonalcoholic steatohepatitis is the fastest-growing indication for the liver transplant and a leading cause of hepatocellular carcinoma among patients listed for liver transplantation in the USA. Post-transplant nonalcoholic hepatic steatosis and steatohepatitis are frequent complications of liver transplantation. Nonalcoholic steatohepatitis poses a significant challenge in both pre- and post-transplant period due to its association with metabolic syndrome, coronary artery disease, chronic kidney disease, and obstructive sleep apnea. While optimal therapy is not yet available in the post-liver transplant setting, lifestyle interventions continue to remain as the mainstay of therapy for post-transplant nonalcoholic steatohepatitis. Early recognition with protocol biopsies and noninvasive modalities, along with modification of known risk factors, are the most effective methods to curtail the progression of nonalcoholic steatohepatitis in the absence of FDA-approved pharmacologic therapy.
Keyphrases
- metabolic syndrome
- risk factors
- chronic kidney disease
- obstructive sleep apnea
- coronary artery disease
- physical activity
- randomized controlled trial
- end stage renal disease
- cardiovascular disease
- positive airway pressure
- heart failure
- insulin resistance
- type diabetes
- percutaneous coronary intervention
- stem cells
- weight loss
- coronary artery bypass grafting
- cardiovascular events
- adipose tissue
- atrial fibrillation
- acute coronary syndrome
- left ventricular
- cell therapy
- aortic valve