NAFLD and NASH in the Patient after Liver Transplantation

The management of patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) after liver transplantation should address both liver disease and metabolic risk factors. The presence of NASH could be considered a risk for progressive disease and graft failure, but its impact on graft function remains unclear due to insufficient data, especially regarding the long term. The most prominent recipient risk factor for the development of NAFLD and NASH after liver transplantation is the presence of the metabolic syndrome, with obesity, hyperlipidemia, diabetes mellitus, and arterial hypertension being associated with de novo NAFLD. The diagnosis of NAFLD and NASH in the patient after liver transplantation requires confirmation by liver biopsy. The risk of developing advanced liver disease because of NASH after liver transplantation is rather low, with cardiovascular events being the leading cause of mortality. The management of post-transplant NASH has to go hand in hand with the management of cardiovascular risk factors.