Nonalcoholic Fatty Liver Disease: Epidemiology, Liver Transplantation Trends and Outcomes, and Risk of Recurrent Disease in the Graft

Abstract

In parallel with the rising prevalence of metabolic syndrome globally, nonalcoholic fatty liver (NAFL) disease is the most common chronic liver disease in Western countries and nonalcoholic steatohepatitis (NASH) has become increasingly associated with hepatocellular carcinoma. Recent studies have identified NASH as the most rapidly growing indication for liver transplantation (LT). As a hepatic manifestation of the metabolic syndrome, NAFL disease can be histologically divided into NAFL and NASH. NAFL is considered a benign condition, with histological changes of hepatocyte steatosis but without evidence of hepatocellular injury or fibrosis. This is distinct from NASH, which is characterized by hepatocyte ballooning and inflammation, and which can progress to fibrosis and cirrhosis, hepatocellular carcinoma, and liver failure. As for any other end-stage liver disease, LT is a curative option for NASH after the onset of decompensated cirrhosis or hepatocellular carcinoma. Although some studies have suggested increased rates of sepsis and cardiovascular complications in the immediate postoperative period, the long-term posttransplant survival of NASH cases is similar to other indications for LT. Recurrence of NAFL following LT is common and can be challenging, although recurrence rates of NASH are lower. The persistence or progression of metabolic syndrome components after LT are likely responsible for NASH recurrence in transplanted liver. Therefore, while maintaining access to LT is important, concerted effort to address the modifiable risk factors and develop effective screening strategies to identify early stages of disease are paramount to effectively tackle this growing epidemic. Citation of this article: Liu A, Galoosian A, Kaswala D, Li AA, Gadiparthi C, Cholankeril G, et al. Nonalcoholic fatty liver disease: Epidemiology, liver transplantation trends and outcomes, and risk of recurrent disease in the graft.

Epidemiological Features of NAFLD From 1999 to 2018 in China

“…Global epidemiology studies have suggested that NAFLD can progress to liver cirrhosis (LC) or HCC, although the exact burden of NAFLD‐related LC and HCC remains uncertain. A study based on the US population revealed that NAFLD is one of the most common etiologies (59%) for HCC, and data from the Scientific Registry of Transplant Recipients for 2002 to 2017 demonstrate that the prevalence of HCC in NASH increased 11.5‐fold and that liver transplant that was due to HCC increased 8.5‐fold in the United States . NASH has also become the fastest growing cause of advanced liver complications .…”

Histological grading evaluation of non-alcoholic fatty liver disease after bariatric surgery: a retrospective and longitudinal observational cohort study

“…www.nature.com/scientificreports www.nature.com/scientificreports/ affection worldwide in the recent decades. On the other hand, liver disease associated with obesity and the consequent evolution to steatosis, steatohepatitis, cirrhosis and hepatocellular carcinoma has become one of the main causes of liver failure and transplantation in recent years, with the aggravating possibility of recurrence in the transplanted organ 36,37 . In our cross-sectional retrospective study, the NAFLD incidence evaluated by histological examination was 46.48% among the morbidly obese patients who underwent bariatric surgery, and 50% in the first timepoint of the paired longitudinal study.…”

Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review

“…The epidemiology of liver diseases has significantly changed over the last years owing to NAFLD continuously growing prevalence in parallel with the decline of chronic hepatitis C virus (HCV) thanks to the advent of highly-effective direct-acting antiviral agents [8]. NAFLD is a multi-system disease representing a relevant health care issue [39].…”

“…Nonalcoholic fatty liver disease (NAFLD), now the most common chronic liver disease (CLD) in developed countries, embraces a spectrum of histopathological conditions ranging from simple relatively benign simple steatosis to nonalcoholic steatohepatitis (NASH), which is associated with progression to fibrosis/cirrhosis and hepatocellular carcinoma [6]. NASH will be the leading cause for liver transplantation by 2020 [7,8]. NAFLD is independently associated with an increased risk of abnormalities of cardiac structure and function, including cardiac rhythm disorders (mainly AF) [9,10].…”