Worldwide Increasing Prevalence of Non-alcoholic Steatohepatitis as an Indication of Liver Transplantation: Epidemiological View and Implications

Non-alcoholic fatty liver disease (NAFLD) has progressively become one of the main causes of chronic liver disease (CLD) in transplant centers on all continents. Most epidemiological studies that demonstrate these trends are country-centered reports. For this reason, this review aimed to collect individual studies carried out in the last decades to appreciate the overwhelming dimension of the problem. Additionally, a summary of the prognostic impact of NAFLD and its comorbidities in the context of liver transplant setting was performed.

Regardless of ethnicity, cultural background, socioeconomic status, or medical infrastructure disparities, the epidemic of obesity and DM has resulted in a drastic and progressive increase in the burden of NAFLD and is stepwise becoming the leading cause of LT worldwide. Although comorbidities will have an impact on pre-transplant morbidity and mortality, post-transplant outcomes are comparable to other etiologies of liver disease.

A multidisciplinary approach to these patients, the careful selection of candidates, and the potential benefit of emerging pharmacological therapies probably contribute to improving the overall prognosis both before and after liver transplantation.