Modernes Management und neue Herausforderungen bei Fettlebererkrankungen

Die nicht-alkoholischen Fettlebererkrankungen (NAFLD) stellen die hepatische Manifestation des metabolischen Syndroms dar und umfassen ein Spektrum von der Steatose über die nichtalkoholische Steatohepatits (NASH) bis zur NASH-Zirrhose. Insgesamt besteht das Risiko eines Fortschreitens der Erkrankung bis zur dekompensierten Zirrhose und Ausbildung eines hepatozellulären Karzinoms (HCC). Damit assoziiert sind gewöhnlich Komorbiditäten wie Adipositas, Diabetes mellitus und kardiovaskuläre Erkrankungen, was ein komplexes Management erforderlich macht. Therapeutische Empfehlungen beginnen bei Modifikationen des Lebensstils über pharmakologische Therapieoptionen bis zur bariatrischen Chirurgie und schließlich Lebertransplantation, wenn eine Zirrhose oder ein HCC vorliegen. Die NASH stellt eine zunehmende Indikation zur Lebertransplantation dar, mit distinkten aber bislang in Studien noch nicht ausreichend untersuchten Erfordernissen für den Umgang mit diesen Patienten vor und nach Lebertransplantation. Die nachfolgende Übersicht fasst den aktuellen Stand zum Management von Patienten mit NASH zusammen.

Non-alcoholic fatty liver diseases (NAFLD) constitute the hepatic manifestation of metabolic syndrome and include a spectrum from simple steatosis to non-alcoholic steatohepatits (NASH) and NASH cirrhosis. Overall, there is a risk of disease progression to decompensated cirrhosis and formation of HCC. Associated comorbidities such as obesity, diabetes and cardiovascular disease require a complex management. Usually therapeutic recommendation begin with lifestyle modifications, rare pharmacological treatment options, bariatric surgery and finally, if cirrhosis or HCC occur, liver transplantation. NASH is becoming an increasing indication for liver transplantation with distinct but not yet sufficiently investigated requirements for the handling of these patients before and after liver transplantation. The following review article summarizes the current status of the management of patients with NAFLD.

Key words

Fatty liver diseases - non-alcoholic fatty liver diseases (NAFLD) - hepatocellular carcinoma (HCC) - comorbidities - pharmacological treatment - bariatric surgery - cirrhosis - liver transplantation

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