International Liver Transplantation Consensus Statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation

Nonalcoholic steatohepatitis (NASH)-related cirrhosis has become one of the most common indications for liver transplantation (LT), particularly in candidates over the age of 65 years. Typically, NASH candidates have concurrent obesity, metabolic and cardiovascular risks, which directly impact patient evaluation and selection, waitlist morbidity and mortality and eventually posttransplant outcomes. The purpose of these guidelines is to highlight specific features commonly observed in NASH candidates and strategies to optimize pretransplant evaluation and waitlist survival. More specifically, the working group addressed the following clinically-relevant questions providing recommendations based on the GRADE system supported by rigorous systematic reviews and consensus: (1) Is the outcome after LT similar to that of other etiologies of liver disease? (2) Is the natural history of NASH-related cirrhosis different from other etiologies of end-stage liver disease? (3) How should cardiovascular risk be assessed in the candidate for LT? Should the assessment differ from that done in other etiologies? (4) How should comorbidities (hypertension, diabetes, dyslipidemia, obesity, renal dysfunction, etc.) be treated in the candidate for LT? Should treatment and monitoring of these comorbidities differ from that applied in other etiologies? (5) What are the therapeutic strategies recommended to improve the cardiovascular and nutritional status of a NASH patient in the waiting list for LT? (6) Is there any circumstance where obesity should contraindicate LT? (7) What is the optimal time for bariatric surgery: before, during, or after LT? and (8) Donor steatosis: how much relevant is it for LT in NASH patients Contributions: All authors drafted sections of the manuscript and revised the final manuscript for important intellectual content. In addition, MB and ET also drafted some of the sections, combined all the sections in a single manuscript, and revised the final before submission. Conflict of interest: ET: none SN: none YT: none YL: Speaker for Gilead. Grants and Speaker for Novartis. MG: none JK: none MB: Speaker for Novartis, Astellas, Gilead. Grant from Gilead. Correspondence information: Marina Berenguer – MD, La Fe University Hospital, Avenida Fernando Abril Martorell, 106 (Torre F5) – 46026 Valencia (Spain), e-mail: marina.berenguer@uv.es Ciberehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas) is partially funded by the Instituto de Salud Carlos III. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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