International liver transplantation consensus statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation
Open accessAbstract
Nonalcoholic steatohepatitis (NASH)-related cirrhosis has become one of the most common indications for liver transplantation (LT), particularly in candidates older than 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 Grading of Recommendation, Assessment, Development and Evaluation (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? (8) How relevant is donor steatosis for LT in NASH patients?
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There is insufficient evidence to support a fundamentally different approach to the pre-transplant cardiovascular risk assessment in MASLD.
“Although MASH is considered an independent risk factor for cardiovascular events similar to other traditional risk factors, there is insuf fi cient evidence to support a fundamentally different approach to the pre-transplant cardiovascular risk assessment, as stated in the ILTS consensus statement. 489”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [489]
At present, there are no prospective randomised-controlled diagnostic trials demonstrating superior outcomes with any specific preoperative screening strategy in individuals with MASLD undergoing liver transplantation.
“At present, there are no prospective randomisedcontrolled diagnostic trials demonstrating superior outcomes with any (speci fi c) preoperative screening strategy in individuals with MASLD undergoing liver transplantation. 489”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [489]
Currently, BMI-based criteria are no longer a contraindication for liver transplantation.
“Currently, BMI-based criteria are no longer a contraindication. 489”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [489]
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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
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Management of metabolic syndrome and cardiovascular risk after liver transplantation
Fatourou, E. M., & Tsochatzis, E. A. (2019) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(19)30181-5 · Cited by 59 · see citing works
Self-citationAuthors, & Collaborators: (2022) · Zeitschrift für Gastroenterologie · doi:10.1055/a-1880-2388 · Cited by 30 · see citing works
Evaluation of recipients with significant comorbidity - patients with cardiovascular disease
Tsochatzis, E. A., Watt, K. D., VanWagner, L. B., Verna, E. C., & Berzigotti, A. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.03.023 · Cited by 22 · see citing works
Self-citationYemini, R., Nesher, E., Braun, M., Cohen, M., Carmeli, I., Mor, E., & Keidar, A. (2021) · Clinical Transplantation · doi:10.1111/ctr.14374 · Cited by 16 · see citing works
Beyazal Polat, H., Beyazal, M., Arpa, M., Kızılkaya, B., Ayaz, T., Gündoğdu, Ö. L., Konur, K., Polat, Z., Beyazal Çeliker, F., & Atasoy, H. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103513 · Cited by 13 · see citing works
Sharma, S., Stine, J. G., Verbeek, T., & Bezinover, D. (2022) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.07.020 · Cited by 5 · see citing works
- Authors
- Tsochatzis, E., Coilly, A., Nadalin, S., Levistky, J., Tokat, Y., Ghobrial, M., Klinck, J., & Berenguer, M.
- Affiliations
- The Royal Free Hospital (GB)
- Université Paris-Sud (FR)
- Universitätsklinikum Tübingen (DE)
- Northwestern University (US)
- Istanbul Florence Nightingale Hospital (TR)
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston, TX.
- University of Cambridge (GB)
- Universitat de València (ES)
- Corresponding author
- Berenguer, Marina
- Venue
- Transplantation
- Published
- 2019-01
- Volume
- 103
- Issue
- 1
- Pages
- 45-56
- ISSN
- 0041-1337 (ISSN-L)
- 1534-6080
- OpenAlex
- W2889466260
- Cited by
- 105
- References
- 125
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 16 · 2023: 12 · 2022: 17 · 2021: 20 · 2020: 14 · 2019: 12 · 2018: 3
- FWCI
- 12.74
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, cc-by-nc)
- 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, end-stage liver disease, pre-transplant evaluation, waitlist survival, cardiovascular risk assessment, obesity, comorbidity management, bariatric surgery, post-transplant outcomes
- MeSH terms
- Cardiovascular Diseases, Consensus Statements as Topic, Humans, Liver Cirrhosis, Obesity, Tissue and Organ Procurement, Time Factors, Waiting Lists, Comorbidity, Liver Transplantation, Treatment Outcome, Consensus, Bariatric Surgery, End Stage Liver Disease, Non-alcoholic Fatty Liver Disease
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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.
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