Liver transplantation and nonalcoholic steatohepatitis: the state of the art

Nonalcoholic fatty liver disease (NAFLD) represents one of the most diffuse liver diseases worldwide. It is a condition ranging from liver steatosis to non-alcoholic steatohepatitis (NASH) and NASH-related cirrhosis. Recently, the term metabolic dysfunction-associated fatty liver disease has been proposed in place of NAFLD, accenting the metabolic and cardiovascular risks that accompany hepatic disease. In the last decades, NASH and NASH-related cirrhosis have been the fastest growing indications for liver transplantation (LT), and they will probably overcome the other indications in next future. After LT, recipients show an important increase in body weight due to a greater caloric intake, partially because of the metabolic influence of immunosuppressant drugs, favoring the development of diabetes mellitus, dyslipidemias, and arterial hypertension. These metabolic complications will, in turn, elevate cardiovascular risk in this population. In this review, we analyze the main metabolic challenges of both pre-and post-LT periods.