title: Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH.
abstract: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and comprises a liver disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) with risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Associated metabolic conditions and comorbidities such as obesity, diabetes and cardiovascular diseases are common and require concerted management. Adiponutrin (PNPLA3) variants may help to identify NAFLD patients at higher risk for liver disease progression towards advanced fibrosis and HCC. The therapeutic options in NAFLD/NASH include lifestyle modification, pharmacological treatment, bariatric surgery for patients with morbid obesity and treatment of complications of liver cirrhosis and HCC, including liver transplantation. Insulin sensitizers and antioxidative treatment strategies with vitamin E are among the best-established pharmacological approaches, but both drugs have long-term safety issues and there is limited evidence in cirrhotic patients. Treatment of concomitant/underlying metabolic conditions with statins or metformin may also have beneficial effects on portal hypertension, complications of liver cirrhosis and HCC prevention. The bile acid receptor FXR may be a promising novel therapeutic target for the treatment of NAFLD/NASH, fibrosis and portal hypertension, but the prognostic implications of associated changes in low- and high-density lipoprotein cholesterol require further studies. Morbidly obese NASH patients can benefit from bariatric surgery which may reduce liver fibrosis but carries a risk of decompensation in patients with advanced liver cirrhosis. When carefully selected, patients with NASH cirrhosis undergoing liver transplantation have a good outcome. This review summarizes recent progress in the management of patients with liver cirrhosis due to NASH.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Traussnigg
authors.forename: Christian
authors.initials: C
authors.lastname: Kienbacher
authors.forename: Emina
authors.initials: E
authors.lastname: Halilbasic
authors.forename: Christian
authors.initials: C
authors.lastname: Rechling
authors.forename: Lili
authors.initials: L
authors.lastname: Kazemi-Shirazi
authors.forename: Harald
authors.initials: H
authors.lastname: Hofer
authors.forename: Petra
authors.initials: P
authors.lastname: Munda
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D050110:Bariatric Surgery; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D018450:Disease Progression; D014644:Genetic Variation; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008049:Lipase / Q000235:genetics; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008113:Liver Neoplasms / Q000209:etiology; D016031:Liver Transplantation; D008565:Membrane Proteins / Q000235:genetics; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy; D008687:Metformin / Q000627:therapeutic use; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000473:pathology / Q000628:therapy*; D009767:Obesity, Morbid / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011379:Prognosis; D018160:Receptors, Cytoplasmic and Nuclear / Q000187:drug effects / Q000378:metabolism; D014810:Vitamin E / Q000627:therapeutic use; D000099150:Receptor, Farnesoid X-Activated; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent
chemical_list: D000924:Anticholesteremic Agents; D000975:Antioxidants; D007004:Hypoglycemic Agents; D008049:Lipase; D008565:Membrane Proteins; D008687:Metformin; D018160:Receptors, Cytoplasmic and Nuclear; D014810:Vitamin E; D000099150:Receptor, Farnesoid X-Activated; C533682:PNPLA3 protein, human; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent