Seo Suk, Maganti Kalyani, Khehra Manjit, Ramsamooj Rajendra, Tsodikov Alexander, Bowlus Christopher, McVicar John, Zern Mark, Torok Natalie
Division of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, CA 95817, USA.
Liver Transpl. 2007 Jun;13(6):844-7. doi: 10.1002/lt.20932.
Hepatic steatosis is a recognized problem in patients after orthotopic liver transplant (OLT). However, de novo development of nonalcoholic fatty liver disease (NAFLD) has not been well described. The aim of this study was to determine the prevalence and predictors of de novo NAFLD after OLT. A retrospective analysis was performed on 68 OLT patients with donor liver biopsies and posttransplantation liver biopsies. Individual medical charts were reviewed for demographics, indication for OLT, serial histology reports, genotypes for hepatitis C, comorbid conditions, and medications. Liver biopsies were reviewed blindly and graded according to the Brunt Scoring System. Multivariate logistic regression analysis was used to study the risk factors for developing NAFLD. The interval time from OLT to subsequent follow-up liver biopsy was 28 +/- 18 months. A total of 12 patients (18%) developed de novo NAFLD, and 6 (9%) developed de novo NASH. The regression model indicated that the use of angiotensin-converting enzyme inhibitors (ACE-I) was associated with a reduced risk of developing NAFLD after OLT (odds ratio, 0.09; 95% confidence interval, 0.010-0.92; P = 0.042). Increase in body mass index (BMI) of greater than 10% after OLT was associated with a higher risk of developing NAFLD (odds ratio, 19.38; 95% confidence interval, 3.50-107.40; P = 0.001). In conclusion, de novo NAFLD is common in the post-OLT setting, with a significant association with weight gain after transplant. The use of an ACE-I may reduce the risk of developing post-OLT NAFLD.
肝脂肪变性是原位肝移植（OLT）术后患者中一个公认的问题。然而，非酒精性脂肪性肝病（NAFLD）的新发情况尚未得到充分描述。本研究的目的是确定OLT术后新发NAFLD的患病率及预测因素。对68例有供体肝活检和移植后肝活检的OLT患者进行了回顾性分析。查阅了个体病历，了解人口统计学资料、OLT指征、系列组织学报告、丙型肝炎基因型、合并症和用药情况。对肝活检进行盲法评估，并根据布伦特评分系统进行分级。采用多因素逻辑回归分析研究发生NAFLD的危险因素。OLT至随后随访肝活检的间隔时间为28±18个月。共有12例患者（18%）发生新发NAFLD，6例（9%）发生新发非酒精性脂肪性肝炎（NASH）。回归模型表明，使用血管紧张素转换酶抑制剂（ACE-I）与OLT术后发生NAFLD的风险降低相关（比值比，0.09；95%置信区间，0.010 - 0.92；P = 0.042）。OLT后体重指数（BMI）增加超过10%与发生NAFLD的风险较高相关（比值比，19.38；95%置信区间，3.50 - 107.40；P = 0.001）。总之，新发NAFLD在OLT术后很常见，并与移植后体重增加显著相关。使用ACE-I可能会降低OLT术后发生NAFLD的风险。
