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Abstract Details
Mechanisms of nonalcoholic fatty liver disease and implications for surgery
Langenbecks Arch Surg. 2020 Aug 24. doi: 10.1007/s00423-020-01965-1.Online ahead of print.
Benedikt Kaufmann12, Agustina Reca1, Baocai Wang2, Helmut Friess2, Ariel E Feldstein1, Daniel Hartmann3
Author information
1Department of Pediatric Gastroenterology, University of California San Diego (UCSD), La Jolla, CA, USA.
2Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
3Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany. daniel.hartmann@tum.de.
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in both adults and children worldwide. Understanding the pathogenic mechanisms behind NAFLD provides the basis for identifying risk factors, such as metabolic syndrome, pancreatoduodenectomy, and host genetics, that lead to the onset and progression of the disease. The progression from steatosis to more severe forms, such as steatohepatitis, fibrosis, and cirrhosis, leads to an increased number of liver and non-liver complications.
Purpose: NAFLD-associated end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) often require surgery as the only curative treatment. In particular, the presence of NAFLD together with the coexisting metabolic comorbidities that usually occur in these patients requires careful preoperative diagnosis and peri-/postoperative management. Bariatric surgery, liver resection, and liver transplantation (LT) have shown favorable results for weight loss, HCC, and ESLD in patients with NAFLD. The LT demand and the increasing spread of NAFLD in the donor pool reinforce the already existing lack of donor organs.
Conclusion: In this review, we will discuss the diverse mechanisms underlying NAFLD, its implications for surgery, and the challenges for patient management.