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World J Hepatol. Dec 27, 2020; 12(12): 1168-1181
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1168
Metabolic associated fatty liver disease: Addressing a new era in liver transplantation
Madeleine G Gill, Avik Majumdar
Madeleine G Gill, Avik Majumdar, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, New South Wales, Australia
Avik Majumdar, Central Clinical School, The University of Sydney, Sydney 2050, New South Wales, Australia
Author contributions: Gill MG is responsible for the concept, drafting the article, critical revision; Majumdar A is responsible for the concept, critical revisions, final approval of article.
Conflict-of-interest statement: No conflicts of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Avik Majumdar, MBBS, MPHTM, FRACP, PhD, Senior Lecturer, Staff Physician, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, New South Wales, Australia. avik.majumdar@health.nsw.gov.au
Received: August 1, 2020
Peer-review started: August 1, 2020
First decision: September 24, 2020
Revised: October 8, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 27, 2020
Processing time: 138 Days and 23 Hours
Abstract

Metabolic associated fatty liver disease (MAFLD), previously termed non-alcoholic fatty liver disease, is the leading global cause of liver disease and is fast becoming the most common indication for liver transplantation. The recent change in nomenclature to MAFLD refocuses the conceptualisation of this disease entity to its metabolic underpinnings and may help to spur a paradigm shift in the approach to its management, including in the setting of liver transplantation. Patients with MAFLD present significant challenges in the pre-, peri- and post-transplant settings, largely due to the presence of medical comorbidities that include obesity, metabolic syndrome and cardiovascular risk factors. As the community prevalence of MAFLD increases concurrently with the obesity epidemic, donor liver steatosis is also a current and future concern. This review outlines current epidemiology, nomenclature, management issues and outcomes of liver transplantation in patients with MAFLD.

Keywords: Fatty liver; Metabolic associated fatty liver disease; Non-alcoholic fatty liver disease; Liver transplantation; Cirrhosis; Metabolic syndrome

Core Tip: Metabolic associated fatty liver disease (MAFLD), previously termed non-alcoholic fatty liver disease, is the leading global cause of liver disease and is becoming the most common indication for liver transplantation. Several challenges exist in the pre-, peri-and post-liver transplant setting for patients with MAFLD, which mostly relate to comorbid medical conditions, obesity and cardiovascular risk. Donor liver steatosis is also an increasing concern. In this review, we summarise the current literature and provide an approach to address the current challenges of MAFLD and liver transplantation.