Nonalcoholic Fatty Liver Disease in the Post Liver Transplant Patient

Nonalcoholic fatty liver disease (NAFLD) may occur as a de novo or recurrent disease among recipients of liver transplant (LT). We seek to review the currently available information on the diagnosis, implications, and management of NAFLD in the post LT population with a focus on the practical medical management of this disease. Recent studies emphasize that NAFLD is the hepatic manifestation of the metabolic syndrome, mediated largely by insulin resistance, with liver recipient factors being the primary determinants of the development of graft steatosis. Post-transplant nonalcoholic steatohepatitis (NASH) may progress to the development of graft fibrosis and cirrhosis. Risk factors such as hypertension, dyslipidemia, hyperglycemia, and excess weight gain should be addressed proactively in the post-transplant period. Interventions to prevent or treat NAFLD in the patient who has undergone LT must take into account the specialized needs of the post-transplant care setting, including the management of immunosuppression, and the potential presence of high catabolic needs after surgery. Future research is needed to tailor NAFLD interventions to the post-transplant population.