Mikolasevic I, Racki S, Lukenda V, Pavletic-Persic M, Milic S, Orlic L
Department of Nephrology and Dialysis, Division of Internal Medicine, University Hospital Center Rijeka, Rijeka, Croatia.
Department of Nephrology and Dialysis, Division of Internal Medicine, University Hospital Center Rijeka, Rijeka, Croatia.
Med Hypotheses. 2014 Jan;82(1):36-9. doi: 10.1016/j.mehy.2013.10.030. Epub 2013 Nov 9.
Despite all improvements in transplant medicine, renal transplant recipients have a high risk for cardiovascular mortality. A high prevalence of cardiovascular complications in renal transplant recipients (RTR) is explained by cardiovascular risk factors present before transplantation, in addition to the development of new risk factors as well as worsening of preexisting risk factors after transplantation. A majority ot these patients develop metabolic syndrome within a year after the transplantation. The metabolic syndrome (MS) is associated with impaired renal allograft function and increased insulin resistance. Non alcoholic fatty liver disease (NAFLD) represents a liver manifestation of metabolic syndrome and it development is strongly associated with all components of MS in general population. The current importance of NAFLD and its link to the MS has encouraged an interest in its possible role in the development of atherosclerosis in recent years. Considering the fact that all components of MS are more common among renal transplant recipients compared to general population, it would be expected that RTR may have a much higher incidence of NAFLD compared to general population. We propose that the presence of NAFLD in RTR could be a strong predictor in cardiovascular morbidity and mortality. Also, according to the recent investigations about the possible link between NAFLD and chronic kidney disease, we hypothesis that NAFLD may be associated with deteriorating graft function, causing a chronic allograft nephropathy and graft loss. Common factors underlying the pathogenesis of NAFLD and chronic allograft dysfunction may be insulin resistance, oxidative stress, activation of rennin-angiotensin system, and inappropriate secretion of inflammatory cytokines by steatotic and inflamed liver.
尽管移植医学有了诸多进步，但肾移植受者仍面临较高的心血管死亡风险。肾移植受者（RTR）心血管并发症的高患病率可归因于移植前就存在的心血管危险因素，此外还包括新危险因素的出现以及移植后原有危险因素的恶化。这些患者中的大多数在移植后一年内会出现代谢综合征。代谢综合征（MS）与肾移植功能受损和胰岛素抵抗增加有关。非酒精性脂肪性肝病（NAFLD）是代谢综合征的一种肝脏表现，其发生与普通人群中MS的所有组成部分密切相关。近年来，NAFLD的当前重要性及其与MS的联系引发了人们对其在动脉粥样硬化发展中可能作用的兴趣。鉴于与普通人群相比，MS的所有组成部分在肾移植受者中更为常见，可以预期RTR的NAFLD发病率可能比普通人群高得多。我们认为RTR中NAFLD的存在可能是心血管发病和死亡的有力预测指标。此外，根据最近关于NAFLD与慢性肾脏病可能联系的调查，我们假设NAFLD可能与移植肾功能恶化有关，导致慢性移植肾肾病和移植肾丢失。NAFLD和慢性移植功能障碍发病机制的共同因素可能是胰岛素抵抗、氧化应激、肾素 - 血管紧张素系统激活以及脂肪变性和炎症肝脏不适当分泌炎性细胞因子。
