title: Reducing the load: the evolution and management of obesity and nonalcoholic steatohepatitis before liver transplantation.
abstract: 1. Obesity is common in patients with end-stage liver disease of any cause. 2. Obesity is associated with comorbidities that can affect liver transplant candidacy, such as metabolic syndrome (diabetes, hyperlipidemia, and hypertension), cardiovascular disease, pulmonary disorders (related to obstructive sleep apnea), renal dysfunction, and malignancies. 3. Nonalcoholic steatohepatitis is the only indication for transplantation that is increasing in frequency, and it may soon become the leading indication. 4. There is no set body mass index above which liver transplantation is contraindicated. Transplant candidacy and outcomes depend on the cumulative comorbidities of the individual patient. 5. Weight loss is an important component of metabolic syndrome management and is recommended before liver transplantation. 6. Bariatric surgery may be considered in carefully selected patients with well-compensated cirrhosis but is not recommended in patients with decompensated cirrhosis.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. watt.kymberly@mayo.edu
authors: Kymberly D
authors: KD
authors: Watt
mesh_terms: D050110:Bariatric Surgery; D015992:Body Mass Index; D015897:Comorbidity; D019468:Disease Management; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000601:surgery*; D005234:Fatty Liver / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome