Kalogirou MS, Giouleme O. Growing challenge of post-liver transplantation non-alcoholic fatty liver disease. World J Transplant 2022; 12(9): 281-287 [PMID: 36187880 DOI: 10.5500/wjt.v12.i9.281]
Corresponding Author of This Article
Maria Styliani Kalogirou, MD, MSc, Doctor, Research Fellow, Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. maria.kalogi32@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2022; 12(9): 281-287 Published online Sep 18, 2022. doi: 10.5500/wjt.v12.i9.281
Growing challenge of post-liver transplantation non-alcoholic fatty liver disease
Maria Styliani Kalogirou, Olga Giouleme
Maria Styliani Kalogirou, Olga Giouleme, Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Kalogirou M wrote the paper; Giouleme O critically revised it for important intellectual content.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Styliani Kalogirou, MD, MSc, Doctor, Research Fellow, Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. maria.kalogi32@gmail.com
Received: June 10, 2022 Peer-review started: June 10, 2022 First decision: July 12, 2022 Revised: July 19, 2022 Accepted: August 12, 2022 Article in press: August 12, 2022 Published online: September 18, 2022
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide, with an estimated prevalence of 25%. Post-liver transplantation (LT) recurrent or de novo hepatic steatosis is a common complication in recipients, irrespective of transplantation indication. Risk factors for graft steatosis mainly include obesity, immunosuppression, donor steatosis, and genetic factors. Liver transplant recipients are at high risk of developing insulin resistance, new-onset diabetes, and post-transplantation metabolic syndrome that is highly associated with immunosuppressive treatment. Post-LT NAFLD is often underdiagnosed due to the poor sensitivity of most routine imaging methods. The gold standard for the diagnosis of hepatic steatosis is liver biopsy, which is, however, limited to more complex cases due to its invasive nature. There is no approved pharmacotherapy in NAFLD. Lifestyle modification remains the cornerstone in NAFLD treatment. Other treatment strategies in post-LT NAFLD include lifestyle modifications, pharmacotherapy, bariatric surgery, and tailored immunosuppression. However, these approaches originate from recommendations in the general population, as there is scarce data regarding the safety and efficacy of current management strategies for NAFLD in liver transplant patients. Future prospective studies are required to achieve tailored treatment for these patients.
Core Tip: Non-alcoholic fatty liver disease (NAFLD) is a common complication in liver transplant recipients. Despite the rising prevalence and potentially progressive nature of this entity, there are currently no recommendations regarding NAFLD diagnosis and management in the post-transplant setting. Future studies are urgently needed to fill this knowledge gap and define optimal diagnostic and treatment approaches in this patient population.
