LAUSR

Despite the slowly progressive nature of NAFLD, the number of patients with NAFLD-related cirrhosis significantly increased. Although the management of patients with cirrhosis constantly evolves, improving the prognosis of NAFLD cirrhotic patients is challenging because it is situated at the crossroads between the liver, the metabolic and the cardiovascular diseases. Therefore, the therapeutic interventions target the liver but also the associated cardiometabolic conditions and should be adapted accordingly. The objective of the current review is to critically discuss the particularities in the management of patients with NAFLD-related cirrhosis. We relied on the recommendations of the scientific societies and discussed them in the specific context of NAFLD cirrhosis and the surrounding cardiometabolic milieu. Here we covered the following aspects: (1) the weight loss strategies through lifestyle interventions to avoid sarcopenia and improve portal hypertension (PHT); (2) the optimal control of metabolic comorbidities in particular type 2 diabetes aimed to improve cardiovascular morbidity/mortality but also to lower the incidence of cirrhosis related complications; we discussed various aspects related to the safety of the oral antidiabetic drugs in cirrhosis; (3) the challenges in performing bariatric surgery in patients with cirrhosis related to the PHT and the risk of cirrhosis decompensation; (4) the particularities in the diagnosis and management of the PHT and the difficulties in managing patients awaiting for liver transplantation; we underlined (5) the difficulties to develop drug and to conduct clinical trials in patients with NAFLD-related cirrhosis and discussed the emerging options to overcome these obstacles.