TY - JOUR
T1 - Evaluation of liver transplant candidates with non-alcoholic steatohepatitis
AU - Esteban, James Philip G.
AU - Asgharpour, Amon
N1 - Publisher Copyright:
© 2022 AME Publishing Company. All rights reserved.
PY - 2022/7
Y1 - 2022/7
N2 - Non-alcoholic steatohepatitis (NASH) is anticipated to become the leading indication for liver transplantation (LT) in the United States in the near future. LT is indicated in patients with NASH-related cirrhosis who have medically refractory hepatic decompensation, synthetic dysfunction, and hepatocellular carcinoma (HCC) meeting certain criteria. The objective of LT evaluation is to determine which patient will derive the most benefit from LT with the least risk, thus maximizing the societal benefits of a limited resource. LT evaluation is a multidisciplinary undertaking involving several specialists, assessment tools, and diagnostic testing. Although the steps involved in LT evaluation are relatively similar across different liver diseases, patients with NASH-related cirrhosis have unique demographic and clinical features that affect transplant outcomes and influence their LT evaluation. LT candidates with NASH should be assessed for metabolic syndrome and obesity, malnutrition and sarcopenia, frailty, and cardiovascular disease. Interventions that treat cardiometabolic co-morbidities and improve patients' nutrition and functionality should be considered in order to improve patient outcomes in the waitlist and after LT.
AB - Non-alcoholic steatohepatitis (NASH) is anticipated to become the leading indication for liver transplantation (LT) in the United States in the near future. LT is indicated in patients with NASH-related cirrhosis who have medically refractory hepatic decompensation, synthetic dysfunction, and hepatocellular carcinoma (HCC) meeting certain criteria. The objective of LT evaluation is to determine which patient will derive the most benefit from LT with the least risk, thus maximizing the societal benefits of a limited resource. LT evaluation is a multidisciplinary undertaking involving several specialists, assessment tools, and diagnostic testing. Although the steps involved in LT evaluation are relatively similar across different liver diseases, patients with NASH-related cirrhosis have unique demographic and clinical features that affect transplant outcomes and influence their LT evaluation. LT candidates with NASH should be assessed for metabolic syndrome and obesity, malnutrition and sarcopenia, frailty, and cardiovascular disease. Interventions that treat cardiometabolic co-morbidities and improve patients' nutrition and functionality should be considered in order to improve patient outcomes in the waitlist and after LT.
KW - Non-alcoholic fatty liver disease (NAFLD)
KW - cardiac risk assessment
KW - cirrhosis
KW - end-stage liver disease
KW - liver transplantation (LT)
KW - non-alcoholic steatohepatitis (NASH)
KW - transplant evaluation
UR - http://www.scopus.com/inward/record.url?scp=85131967777&partnerID=8YFLogxK
U2 - 10.21037/tgh.2020.03.04
DO - 10.21037/tgh.2020.03.04
M3 - Review article
AN - SCOPUS:85131967777
SN - 2224-476X
VL - 7
JO - Translational Gastroenterology and Hepatology
JF - Translational Gastroenterology and Hepatology
M1 - 6012
ER -