ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases globally, and NAFLD-associated cirrhosis is becoming a leading indication for liver transplantation (LT). The post-LT survival of patients with a pre-LT diagnosis of nonalcoholic steatohepatitis (NASH) is similar or better than other indications such as alcohol and hepatitis C. Metabolic syndrome is common post-LT, with prevalence increasing with time from LT. As the number of transplant recipients with NASH rises, attention has turned to understanding the unique risks of this population, who are older at the time of LT and have higher rates of metabolic comorbidities such as obesity, diabetes and hypertension. The prevalence of hyperlipidemia is estimated to vary from 27 to 71% among LT recipients. Most of the drug classes commonly used for immunosuppression have some metabolic consequences, and for patients with preexisting metabolic comorbidities, immunosuppressive drugs can exacerbate risk of metabolic complications post-LT.
