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Esteban JPG, Asgharpour A. Evaluation of liver transplant candidates with non-alcoholic steatohepatitis. Transl Gastroenterol Hepatol 2022; 7:24. [PMID: 35892057 PMCID: PMC9257540 DOI: 10.21037/tgh.2020.03.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/03/2020] [Indexed: 11/07/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is anticipated to become the leading indication for liver transplantation (LT) in the United States in the near future. LT is indicated in patients with NASH-related cirrhosis who have medically refractory hepatic decompensation, synthetic dysfunction, and hepatocellular carcinoma (HCC) meeting certain criteria. The objective of LT evaluation is to determine which patient will derive the most benefit from LT with the least risk, thus maximizing the societal benefits of a limited resource. LT evaluation is a multidisciplinary undertaking involving several specialists, assessment tools, and diagnostic testing. Although the steps involved in LT evaluation are relatively similar across different liver diseases, patients with NASH-related cirrhosis have unique demographic and clinical features that affect transplant outcomes and influence their LT evaluation. LT candidates with NASH should be assessed for metabolic syndrome and obesity, malnutrition and sarcopenia, frailty, and cardiovascular disease. Interventions that treat cardiometabolic co-morbidities and improve patients' nutrition and functionality should be considered in order to improve patient outcomes in the waitlist and after LT.
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Affiliation(s)
- James Philip G Esteban
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amon Asgharpour
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common form of liver disease, associated with features of the metabolic syndrome. Nonalcoholic steatohepatitis (NASH), the aggressive subtype of NAFLD, can cause progressive fibrosis leading to cirrhosis. With the obesity epidemic, there is an increased health care burden from NASH, one of the most common causes of liver transplantation in the United States. There currently are no Food and Drug Administration-approved medical therapies for NASH. There exists a need for therapeutics to correct the drivers of NASH and to reverse or halt fibrosis progression. This article reviews pharmacologic therapeutics being developed to treat NASH.
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Affiliation(s)
- James Philip G Esteban
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 8701 Watertown Plak Road, Milwaukee, WI 53226, USA; Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, Institute of liver medicine at Mount Sinai, 17 E 102nd St 8th floor, New York, NY 10029, USA
| | - Amon Asgharpour
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, Institute of liver medicine at Mount Sinai, 17 E 102nd St 8th floor, New York, NY 10029, USA.
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Esteban JPG, Rein L, Szabo A, Saeian K, Rhodes M, Marks S. Attitudes of Liver and Palliative Care Clinicians toward Specialist Palliative Care Consultation for Patients with End-Stage Liver Disease. J Palliat Med 2019; 22:804-813. [DOI: 10.1089/jpm.2018.0553] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Lisa Rein
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Rhodes
- Section of Palliative Care, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean Marks
- Section of Palliative Care, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Chakradeo PS, Keshavarzian A, Singh S, Dera AE, Esteban JPG, Lee AA, Burgess HJ, Fogg L, Swanson GR. Chronotype, social jet lag, sleep debt and food timing in inflammatory bowel disease. Sleep Med 2018; 52:188-195. [PMID: 30243610 DOI: 10.1016/j.sleep.2018.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/29/2022]
Abstract
The preference of the sleep/wake cycle can be grouped into categories or chronotypes. Inflammatory bowel disease (IBD) has been linked to poor sleep quality which correlates with disease severity. Social jet lag (SJL) is the difference between sleep timing on work and free days and is a marker for circadian misalignment which has been linked to increased inflammation. We investigated whether chronotype, SJL, sleep debt (SD), and food timing were associated with an IBD specific complications and a lower quality of life. Overall, 191 subjects (115 IBD subjects and 76 healthy controls (HC)) completed the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Munich ChronoType Questionnaire (MCTQ), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and a structured Food Timing Questionnaire. Later chronotype (by MEQ) was associated with a worse SIBDQ (r = -0.209; P < 0.05). SJL was increased in IBD at 1.32 h ± 1.03 vs. 1.05 h ± 0.97 in HC, P < 0.05, when adjusted for age. SJL (>2 h) was present in 40% of severe/complicated Crohn's patients (fistulizing or structuring Crohn's or history of Crohn's related surgery) compared to only 16% of uncomplicated Crohn's patients (P < 0.05). Sleep debt was increased in IBD subjects compared to HC at 21.90 m ± 25.37 vs. 11.49 m ± 13.58, P < 0.05. IBD subjects with inconsistent breakfast or dinner times had lower SIBDQ scores (4.78 ± 1.28 vs. 5.49 ± 1.02, P < 0.05; 4.95 ± 0.31 vs. 5.42 ± 0.32, P < 0.05 respectively). In summary, later chronotype, and markers of circadian misalignment (social jet lag, sleep debt, and inconsistent meal timing) were associated with IBD disease specific complications and/or lower quality of life.
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Affiliation(s)
- Prachi S Chakradeo
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, United States.
| | - Ali Keshavarzian
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, United States.
| | - Shubha Singh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, United States.
| | - Akram E Dera
- Internal Medicine, Greater Baltimore Medical Center, Towson, MD, United States.
| | | | - Alice A Lee
- Rush University Medical Center, Chicago, IL, 60612, United States.
| | - Helen J Burgess
- Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, 60612, United States.
| | - Louis Fogg
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, United States.
| | - Garth R Swanson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Rush University Medical Center, 1725 W. Harrison, Suite 206, Chicago, IL, 60612, United States.
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