Vallin Mélanie, Guillaud Olivier, Boillot Olivier, Hervieu Valérie, Scoazec Jean-Yves, Dumortier Jérôme
Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Digestive Diseases, Lyon, France.
Liver Transpl. 2014 Sep;20(9):1064-71. doi: 10.1002/lt.23936.
Nonalcoholic fatty liver disease (NAFLD) is a potential long-term complication after liver transplantation (LT) and can occur as recurrent disease in patients undergoing transplantation for NAFLD or as de novo NAFLD in others. The aim of this study was to compare these 2 different entities. From a cohort of adult patients undergoing transplantation between 2000 and 2010, we selected all patients with a diagnosis of NAFLD made during liver biopsy examinations during post-LT follow-up; clinical, biological, and histological features of patients with recurrent NAFLD and patients with de novo NAFLD were compared. The diagnosis of post-LT NAFLD was made for 91 patients during the study period: 11 cases were classified as recurrent NAFLD, and 80 cases were classified as de novo NAFLD. The groups were not statistically different with respect to the sex ratio, age, prevalence of hypercholesterolemia, prevalence of obesity, or prevalence of hypertension. The prevalence of diabetes mellitus was higher in patients with recurrent NAFLD (100% versus 37.5%, p < 0.01). At 5 years, severe fibrosis (stage 3 or 4) and steatohepatitis were more frequent in patients with recurrent NAFLD versus patients with de novo NAFLD [71.4% versus 12.5% (P < 0.01) and 71.4% versus 17.2% (P < 0.01), respectively]. NAFLD was already present in 67% of the patients with de novo NAFLD and in 100% of the patients with recurrent NAFLD after 1 year. According to successive liver biopsies, steatosis disappeared in 18 patients (22.5%) with de novo NAFLD and in none of the patients with recurrent NAFLD. In conclusion, our results strongly suggest that recurrent NAFLD and de novo NAFLD after LT are different entities; recurrent NAFLD appears to be a more severe and irreversible disease with an earlier onset.
非酒精性脂肪性肝病（NAFLD）是肝移植（LT）后一种潜在的长期并发症，可作为复发性疾病发生于因NAFLD接受移植的患者，或作为新发NAFLD发生于其他患者。本研究的目的是比较这两种不同的情况。在2000年至2010年间接受移植的成年患者队列中，我们选择了所有在LT术后随访期间肝活检检查时诊断为NAFLD的患者；比较复发性NAFLD患者和新发NAFLD患者的临床、生物学和组织学特征。在研究期间，91例患者被诊断为LT术后NAFLD：11例被分类为复发性NAFLD，80例被分类为新发NAFLD。两组在性别比例、年龄、高胆固醇血症患病率、肥胖患病率或高血压患病率方面无统计学差异。复发性NAFLD患者的糖尿病患病率更高（100%对37.5%，p＜0.01）。5年后，复发性NAFLD患者的严重纤维化（3期或4期）和脂肪性肝炎比新发NAFLD患者更常见[分别为71.4%对12.5%（P＜0.01）和71.4%对17.2%（P＜0.01）]。1年后，67%的新发NAFLD患者和100%的复发性NAFLD患者已存在NAFLD。根据连续的肝活检，18例（22.5%）新发NAFLD患者的脂肪变性消失，而复发性NAFLD患者无一例脂肪变性消失。总之，我们的结果强烈表明，LT术后复发性NAFLD和新发NAFLD是不同的情况；复发性NAFLD似乎是一种更严重且不可逆的疾病，发病更早。
