Hanouneh I A, Zein N N
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
Minerva Gastroenterol Dietol. 2010 Sep;56(3):297-304.
Non-alcoholic fatty liver disease (NAFLD), an important consequence of the global epidemic of obesity, is a common indication of orthotopic liver transplantation in the western world. Currently, NAFLD is the fourth most common indication of liver transplantation in the United Stated with prediction for increase demand of liver transplantation for NAFLD cirrhosis in the next two decades to exceed that of liver transplantation for chronic hepatitis C virus infection. Given the advances in the efficacy and tolerability of immunosuppressive agents which have reduced the incidence of chronic rejection, long-term survival rates after liver transplantation have remarkably improved. Today, long-term graft loss and death after liver transplantation are commonly related to age-related complications, such as cardiovascular disease. Features of metabolic syndrome including obesity, hypertension, hyperglycemia and dyslipidemia are very prevalent and almost universal after liver transplantation. These metabolic derangements are intricately associated with cardiovascular events and have emerged as the leading cause of morbidity and mortality after liver transplantation. In addition, the international epidemic of obesity has negatively impacted the liver transplant candidacy. Because obesity is associated with poor postoperative outcome, many transplant centers decline liver transplantation for morbidly obese individuals above certain level of body mass index.
非酒精性脂肪性肝病（NAFLD）是全球肥胖流行的一个重要后果，是西方世界原位肝移植的常见适应症。目前，NAFLD是美国肝移植的第四大常见适应症，预计在未来二十年内，因NAFLD肝硬化而进行肝移植的需求增长将超过因慢性丙型肝炎病毒感染而进行肝移植的需求。鉴于免疫抑制剂在疗效和耐受性方面的进展降低了慢性排斥反应的发生率，肝移植后的长期生存率有了显著提高。如今，肝移植后的长期移植物丢失和死亡通常与年龄相关的并发症有关，如心血管疾病。代谢综合征的特征包括肥胖、高血压、高血糖和血脂异常，在肝移植后非常普遍，几乎是普遍存在的。这些代谢紊乱与心血管事件密切相关，并已成为肝移植后发病和死亡的主要原因。此外，全球肥胖流行对肝移植候选资格产生了负面影响。由于肥胖与术后不良结局相关，许多移植中心拒绝为体重指数超过一定水平的病态肥胖个体进行肝移植。
