Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome after Liver Transplant

Abstract

Liver transplant is the unique curative therapy for patients with acute liver failure or end-stage liver disease, with or without hepatocellular carcinoma. Increase of body weight, onset of insulin resistance and drug-induced alterations of metabolism are reported in liver transplant recipients. In this context, post-transplant diabetes mellitus, hyperlipidemia, and arterial hypertension can be often diagnosed. Multifactorial illnesses occurring in the post-transplant period represent significant causes of morbidity and mortality. This is especially true for metabolic syndrome. Non-alcoholic steatosis and steatohepatitis are hepatic manifestations of metabolic syndrome and after liver transplant both recurrent and de novo steatosis can be found. Usually, post-transplant steatosis shows an indolent outcome with few cases of fibrosis progression. However, in the post-transplant setting, both metabolic syndrome and steatosis might play a key role in the stratification of morbidity and mortality risk, being commonly associated with cardiovascular disease. The single components of metabolic syndrome can be treated with targeted drugs while lifestyle intervention is the only reasonable therapeutic approach for transplant patients with non-alcoholic steatosis or steatohepatitis.

Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

“…The development of metabolic comorbidities, combined with this higher post-LT survival, contributes to morbidity and mortality rates. Subsequently, the focus of research is changing to long-term complications, such as CVD[ 70 - 72 ]. CVD can be initiated with every insulin resistance (IR) associated component of MetS.…”

“…Furthermore, the clinical features and prevalence of MetS, such as T2DM, hypertension, rapid weight gain and dyslipidemia, often deteriorate in the post-LT period based on transplant specific factors, for example, adverse events in immunosuppression. They are also related to the recipients’ morbidity and mortality[ 70 , 72 ]. For metabolic balance, for hyperglycemia, weight gain, hypertension and hyperlipidemia, immunosuppressant drugs, such as corticosteroids, calcineurin inhibitors (CNIs) (cyclosporine (CSA), tacrolimus (TAC)) and mammalian target of rapamycin inhibitors (mTORs) (such as sirolimus (SIR) and everolimus), have a crucial role.…”

“…Finally, for dyslipidemia, mTORs are the most unfavorable immunosuppressive drugs. These groups of immunosuppressive drugs may, to an extent, affect the development of CVD through metabolic complications[ 70 - 72 ]. Most transplanted patients become obese after LT, with the highest increase in weight occurring after the first six months, as well as one and three years after LT[ 70 , 72 , 73 ].…”

The role of serum hyaluronic acid determination in the diagnosis of liver fibrosis

“…A metabolic syndrome and liver transplantation remain the main causes of these diseases. Both of these conditions can progress to a liver fibrosis and cirrhosis (Gitto & Villa, 2016). Therefore, an early detection of NAFLD and distinguishing non-alcoholic and alcoholic chronic liver diseases is very important.…”

NAFLD: Is There Anything New under the Sun?

“…On this background, Gitto and Villa addressed a specific and often overlooked aspect. These authors reported that following liver transplant both recurrent and de novo NAFLD can be found, which usually follows an indolent course with very few cases of liver fibrosis progression [ 50 ]. Clinicians should therefore use the diagnosis of NAFLD in the post-liver transplant phase as a marker of increased cardiovascular and CKD risks [ 50 ].…”