NAFLD Is The Top Disease Requiring Liver Transplant

By Mirella Perez
Article Published: September 1, 2021

NASH patients awaiting liver transplants increased by 170%

Liver disease has steadily grown over the past 30 years to levels which qualify it as a pandemic. There is no single root cause for developing liver disease, however there are specific triggers which drive the disease forward to unprecedented levels.  

Liver disease associated with NAFLD is a multisystem disease that is closely tied to cardiovascular disease, chronic kidney disease, Type 2 Diabetes. In addition, a major cause of morbidity and mortality in NAFLD patients is also with other liver-related diseases, such as cirrhosis and liver cancer. Cancer is the sixth most common cancer in the world that is predisposed with the presence of cirrhosis. Emerging data suggests that HCC can progress to non-cirrhotic NAFLD and is strongly associated with metabolic syndrome.    

All these different types of liver disease, if not medically regulated, will require a liver transplantation the future.  Once seen as the solution of liver disease, however it is still riddled with complications.  Most patient that receives a new liver, with specific lifestyle changes, will gain many additional years of good health.  However, for some patients a liver transplant will not improve their condition and require re-transplantation, especially if comorbidities exist with NASH.  

This is a major concern since a liver transplant is expensive and there is a shortage of high-quality livers.  According to the World Journal of Gastroenterology, it was observed across reports that recurrent NAFLD has become relatively common after liver transplant. There still needs to be more research done to determine an approximate percentage of patients experiencing post liver transplant NAFLD. Vallin et al., published a small study with 91 patients who underwent liver transplants. All 91 patients were given a diagnosis of post liver transplant NAFLD; 11 patients were diagnosed with recurrent NAFLD (severe and irreversible) and 80 were diagnosed with de novo NAFLD.   

As liver disease continues to grow, the gap between demand and supply for healthy livers continues also to increase. As a result, transplant centers have been resorting to use livers from extended criteria donors (i.e., livers that present steatosis). According to a systemic review done by Michael J Chu and his colleagues, for donor livers that are more than 30% steatotic, there is a decreased graft survival rate and impaired graft functioning (i.e., liver regeneration). Additionally, a study done by Kim et al. showed that patients, who received a liver graft from a donor with preexisting steatosis, were associated with a threefold increased risk for post liver transplant NAFLD. When selecting LT candidates who have NASH, the largest challenge is managing these risk factors.  Patients with comorbidities or who resume an unhealthy lifestyle, will continue to have the risk of developing NAFLD in a transplanted liver.  

The lack of healthy livers globally, is becoming a major problem and could result in two outcomes. One; low quality livers will be used in transplants which will result in greater risk for post-transplantation complications. Two; the use of steatotic donor livers will be decreased, but time on the liver transplant waiting list will become longer and result in increased liver transplant costs and increased wait-list mortality. With the increasing demand of liver transplants and decreasing supply of healthy donor livers in addition to the recurrence of NAFLD in post liver transplant patients, research needs to focus on cost effective alternative treatments. PrimeGen PGUSXC-CL1 can save billions in healthcare costs and millions of lives through the restoration of normal liver function. We are on a mission to lead the stem cell revolution and treat debilitating inflammatory diseases like NAFLD and AFLD

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