Non-alcoholic Fatty Liver Disease as an Indication for Liver Transplantation

Obesity and the metabolic syndrome are becoming more prevalent worldwide, especially in developed countries. Since liver fat and non-alcoholic fatty liver disease (NAFLD) are tightly linked to obesity and metabolic syndrome, the prevalence of NAFLD and non-alcoholic steatohepatitis is rising commensurately. There are typically two different indications for liver transplantation for patients with NAFLD: the development of end-stage liver disease with an expected survival of less than 1 year; or the development of hepatocellular carcinoma. The ultimate diagnosis of NASH can be challenging in a patient admitted to a transplant center because of decompensated liver cirrhosis. The assessment of obesity in patients awaiting liver transplantation can be difficult due to the presence of ascites and edema. Patients with diabetes mellitus are at increased risk of progression to NASH and end-stage liver disease. Patients with NAFLD are at higher risk of cardiovascular events than patients without NAFLD and risk increases with more advanced disease.