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Management of Recurrent and De Novo NAFLD/NASH After Liver Transplantation

Germani, Giacomo, MD, PhD1; Laryea, Marie, MD2; Rubbia-Brandt, Laura, MD3; Egawa, Hiroto, MD4; Burra, Patrizia, MD1; O'Grady, John, MD5; Watt, Kymberly D., MD6

doi: 10.1097/TP.0000000000002485

Nonalcoholic steatohepatitis (NASH) is a growing indication for liver transplant whether the primary or secondary cause of liver disease, and it is expected to be the leading indication in the years to come. Nonalcoholic steatohepatitis recurs after transplant but the impact of the recurrence on allograft and patient outcomes is unclear. A group of multidisciplinary transplant practice providers convened at the International Liver Transplantation Society NASH consensus conference with the purpose of determining the current knowledge and future directions for understanding the recurrence rates, risk and management of NASH in the transplant allograft. Specific questions relating to posttransplant NASH were proposed and reviewed in detail with recommendations on future actions to fill the knowledge gaps.

1 Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.

2 University of Rochester Medical Center, Rochester NY.

3 Pathology Department, Hôpitaux Universitaires Geneve, Geneva, Switzerland.

4 Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.

5 Institute of Liver Studies, King's College Hospital, London, United Kingdom.

6 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Received 15 July 2018. Revision received 30 September 2018.

Accepted 5 October 2018.

The authors declare no funding or conflicts of interest.

All authors contributed to the writing of the article. G.G. and K.D.W. lead the consensus group and organized the consensus review meeting and writing of the article. Additional members of the consensus meeting are acknowledged.

Correspondence: Kymberly D. Watt, MD, Division of Gastroenterology and Hepatology, William J vonLeibig Transplant Center, 200 First St SW, Rochester, MN 55905. (

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