Management of patients with non-alcoholic steatohepatitis undergoing liver transplantation: considerations for the anesthesiologist
Abstract
Non-alcoholic fatty liver disease (NAFLD) currently affects more than 25% of the world population and is rising. NAFLD can progress to non-alcoholic steatohepatitis that is associated with hepatic inflammation and fibrosis and can result in cirrhosis with subsequent liver failure. Non-alcoholic steatohepatitis (NASH) has now emerged as one of the leading etiologies for a liver transplant among adults in the United States. Given the rising incidence of liver transplants in patients with NASH-related cirrhosis, it is essential for anesthesiologists to be familiar with this condition as well as with NASH-related comorbidities and perioperative complications. Not only is NASH linked to metabolic syndrome, but it also is independently associated with cardiovascular disease, renal and thyroid dysfunction, obstructive sleep apnea (OSA), and a hypercoagulable state. The association with these conditions can affect the perioperative outcome of these patients, particularly because of increased mortality from major adverse cardiovascular events and sepsis. In order to decrease the perioperative morbidity and mortality of patients with NASH undergoing a liver transplant, a multidisciplinary approach to their perioperative management is essential, along with careful preoperative evaluation and aggressive intraoperative and postoperative monitoring. The focus of this review article is to provide a comprehensive overview of challenges associated with liver transplants in patients with NASH and to provide suggestions for appropriate patient selection and perioperative management.
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MASLD/MASH is independently associated with cardiovascular diseases, renal and thyroid dysfunction, OSA, and a hypercoagulable state, which can affect perioperative outcomes.
“MASLD/MASH is independently associated with cardiovascular diseases, renal and thyroid dysfunction, OSA, and a hypercoagulable state, which can affect perioperative outcomes. 484”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [484]
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Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
(2024) · Obesity Facts · doi:10.1159/000539371 · Cited by 510 · see citing works
Silymarin for adults with metabolic dysfunction-associated steatotic liver disease
Wang, C., Shang, Y., Kanaan, G., Chai, L., Li, H., & Qi, X. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015524.pub2 · Cited by 4 · see citing works
Silymarin for treatment of adults with nonalcoholic fatty liver disease
Wang, C., Kanaan, G., Shang, Y., Chai, L., Li, H., & Qi, X. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015524 · Cited by 3 · see citing works
Liver transplantation and nonalcoholic steatohepatitis: the state of the art
Gitto, S., Mannelli, N., Tassi, A., Gabrielli, F., Nascimbeni, F., & Andreoné, P. (2022) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2022.04 · Cited by 1 · see citing works
- Authors
- Sharma, S., Stine, J. G., Verbeek, T., & Bezinover, D.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Sharma, Sonal
- Venue
- Journal of Cardiothoracic and Vascular Anesthesia
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 36
- Issue
- 8
- Pages
- 2616-2627
- ISSN
- 1053-0770 (ISSN-L)
- OpenAlex
- W3185650511
- Cited by
- 5
- References
- 159
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1
- FWCI
- 0.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Cardiothoracic and Vascular Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- nonalcoholic steatohepatitis, liver transplantation, perioperative care, anesthesiology, metabolic syndrome, cardiovascular disease, sepsis, hypercoagulability, obstructive sleep apnea, patient selection, preoperative assessment, intraoperative monitoring, postoperative monitoring
- MeSH terms
- Anesthesiologists, Adult, Cardiovascular Diseases, Humans, Liver Cirrhosis, United States, Liver Transplantation, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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