Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Liver Transpl. 2009 Dec;15(12):1662-70. doi: 10.1002/lt.21952.
With increasing survival after orthotopic liver transplantation (OLT), metabolic syndrome and its individual components, including diabetes mellitus, hypertension, dyslipidemia, and obesity, are increasingly being identified and contributing to cardiovascular complications and late morbidity and mortality. The prevalence of posttransplant metabolic syndrome (PTMS) and its individual components has been found to be higher post-OLT versus a comparable population without OLT. The development of nonalcoholic fatty liver disease (NAFLD) after liver transplantation for non-NAFLD cirrhosis is also being increasingly recognized. A number of predictors have been identified as potential risk factors related to these complications. The pretransplant risk factors include immunosuppression, a higher age at transplant, male gender, a history of smoking, the pretransplant body mass index, pre-OLT diabetes, the etiology of the underlying liver disease that resulted in OLT (hepatitis C, cryptogenic cirrhosis, or alcohol), an increased donor body mass index, and marital status. Although there is an increased risk of cardiovascular events, rejection, and infection among patients with PTMS, the overall impact on long-term survival and mortality remains inconclusive. Strategies to reduce the development of metabolic syndrome after transplantation should include lifestyle modifications involving alterations in diet and increased physical activity. Additional measures that may be potentially beneficial include the use of lipid-lowering agents, the optimal control of blood glucose, and the use of tacrolimus instead of cyclosporine.
随着原位肝移植（OLT）后生存率的提高，代谢综合征及其各个组成部分，包括糖尿病、高血压、血脂异常和肥胖症，越来越多地被发现，并导致心血管并发症和晚期发病率和死亡率。与未接受 OLT 的可比人群相比，移植后代谢综合征（PTMS）及其各个组成部分的患病率更高。非酒精性脂肪性肝病（NAFLD）在非 NAFLD 肝硬化患者肝移植后的发生也越来越受到关注。许多预测因素已被确定为与这些并发症相关的潜在危险因素。移植前的危险因素包括免疫抑制、移植时年龄较大、男性、吸烟史、移植前的体重指数、OLT 前的糖尿病、导致 OLT 的基础肝病病因（丙型肝炎、隐源性肝硬化或酒精）、供体体重指数增加和婚姻状况。尽管 PTMS 患者发生心血管事件、排斥反应和感染的风险增加，但对长期生存和死亡率的总体影响仍不确定。减少移植后代谢综合征发展的策略应包括涉及饮食改变和增加身体活动的生活方式改变。可能有益的其他措施包括使用降脂药物、血糖的最佳控制以及使用他克莫司代替环孢素。
