Abstract
The prevalence of cirrhosis due to nonalcoholic steatohepatitis (NASH) has increased
2.5-fold in the United States in the last decade. These patients pose new challenges
to hepatologists given their older age and higher frequency of coexisting metabolic
diseases such as obesity and diabetes compared with other etiologies of liver disease.
Patients with NASH cirrhosis are at higher risk for renal and cardiovascular disease,
and the presence of these extrahepatic comorbidities has a significant impact on outcomes
and survival. This review outlines how NASH cirrhosis differs from other etiologies
of cirrhosis including natural history, noninvasive assessment, and the challenges
in the management of the complications of cirrhosis including hepatic encephalopathy
and hepatocellular carcinoma. Nutritional assessment and the impact of sarcopenic
obesity and frailty in this population, and strategies to address the latter, are
discussed. This review also addresses liver transplantation in patients with NASH
cirrhosis in relation to assessment and posttransplant care.
Keywords
nonalcoholic fatty liver - steatohepatitis - cirrhosis - challenges
