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World J Gastroenterol. Nov 14, 2014; 20(42): 15532-15538
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15532
Liver transplantation and non-alcoholic fatty liver disease
Petros Zezos, Eberhard L Renner
Petros Zezos, Eberhard L Renner, Liver Transplant Program/Multi-Organ Transplant Program, University Health Network/Toronto General Hospital, University of Toronto, Toronto, Ontario M5G 2N2, Canada
Author contributions: Zezos P searched and reviewed the literature, and wrote the manuscript; Renner EL advised on searching the literature, contributed to developing the manuscript outline, and reviewed the manuscript.
Correspondence to: Petros Zezos, MD, Liver Transplant Program/Multi-Organ Transplant Program, University Health Network/Toronto General Hospital, University of Toronto, 585 University Avenue, NCSB 11C-1238, Toronto, Ontario M5G 2N2, Canada. zezosp13@hotmail.com
Telephone: +1-416-3406821 Fax: +1-416-340-3126
Received: January 10, 2014
Revised: February 13, 2014
Accepted: June 14, 2014
Published online: November 14, 2014
Abstract

Non-alcoholic fatty liver disease (NAFLD) is an important health problem worldwide. NAFLD encompasses a histological spectrum ranging from bland liver steatosis to severe steatohepatitis (nonalcoholic steatohepatitis, NASH) with the potential of progressing to cirrhosis and its associated morbidity and mortality. NAFLD is thought to be the hepatic manifestation of insulin resistance (or the metabolic syndrome); its prevalence is increasing worldwide in parallel with the obesity epidemic. In many developed countries, NAFLD is the most common cause of liver disease and NASH related cirrhosis is currently the third most common indication for liver transplantation. NASH related cirrhosis is anticipated to become the leading indication for liver transplantation within the next one or two decades. In this review, we discuss how liver transplantation is affected by NAFLD, specifically the following: (1) the increasing need for liver transplantation due to NASH; (2) the impact of the increasing prevalence of NAFLD in the general population on the quality of deceased and live donor livers available for transplantation; (3) the long term graft and patient outcomes after liver transplantation for NASH, and finally; and (4) the de novo occurrence of NAFLD/NASH after liver transplantation and its impact on graft and patient outcomes.

Keywords: Liver transplantation, Non-alcoholic fatty liver disease, Hepatic steatosis, Steatohepatitis, Liver cirrhosis, Metabolic syndrome, Insulin resistance, Obesity

Core tip: Nonalcoholic steatohepatitis (NASH) related cirrhosis is anticipated to become the leading indication for liver transplantation within the next one or two decades. In this review, we discuss how liver transplantation is affected by non-alcoholic fatty liver disease (NAFLD), specifically the following: the increasing need for liver transplantation due to NASH; the impact of the increasing prevalence of NAFLD in the general population on the quality of deceased and live donor livers available for transplantation; the long term graft and patients outcomes after liver transplantation for NASH, and, finally; the de novo occurrence of NAFLD/NASH after liver transplantation and its impact on graft and patient outcomes.