Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Curr Opin Organ Transplant. 2013 Jun;18(3):251-8. doi: 10.1097/MOT.0b013e3283615d30.
Nonalcoholic steatohepatitis (NASH), obesity, and the metabolic syndrome are highly prevalent. NASH, a rare indication for liver transplantation in the early 1990s, is now the third most common indication. This review considers key aspects of the liver transplantation for NASH.
NASH is one consequence of obesity, almost always occurring in the context of metabolic syndrome and oxidative stress. Recurrence of NASH can be severe. The components of metabolic syndrome are often exacerbated following liver transplantation by factors such as immunosuppression, and are important predictors of patient morbidity and mortality. Many aspects of the metabolic syndrome are modifiable. The roles bariatric surgery, nutritional and pharmacotherapy of NASH, and the impact of established and new immunosuppressive agents have recently evolved.
A nuanced approach is needed in management of obesity, metabolic syndrome, and immunosuppression in liver transplant recipients.
非酒精性脂肪性肝炎（NASH）、肥胖和代谢综合征的患病率很高。NASH 是 90 年代初肝移植的罕见适应证，现在是第三大常见适应证。本文综述了肝移植治疗 NASH 的关键方面。
NASH 是肥胖的后果之一，几乎总是发生在代谢综合征和氧化应激的背景下。NASH 的复发可能很严重。代谢综合征的成分在肝移植后常常因免疫抑制等因素而加重，是患者发病率和死亡率的重要预测因素。代谢综合征的许多方面是可以改变的。减肥手术、NASH 的营养和药物治疗以及已确立和新的免疫抑制剂的作用最近发生了演变。
肝移植受者的肥胖、代谢综合征和免疫抑制的管理需要采取细致的方法。
