Jiménez-Pérez Miguel, González-Grande Rocío, Omonte Guzmán Edith, Amo Trillo Víctor, Rodrigo López Juan Miguel
Miguel Jiménez-Pérez, Rocío González-Grande, Edith Omonte Guzmán, Víctor Amo Trillo, Juan Miguel Rodrigo López, UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Universitario Regional de Málaga, 29010 Málaga, Spain.
World J Gastroenterol. 2016 Jul 28;22(28):6416-23. doi: 10.3748/wjg.v22.i28.6416.
The metabolic syndrome (MS), which includes obesity, dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease (CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease (NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.
根据目前广泛采用的定义，代谢综合征（MS）包括肥胖、血脂异常、高血压和高血糖，是移植后最常见的并发症之一，患病率为44%-58%。MS与免疫抑制一起，被认为是移植受者发生心血管疾病（CVD）的主要危险因素，而CVD又占所有与移植无关死亡的19%-42%。MS的存在意味着发生CVD和死亡的相对风险为1.78。另一方面，非酒精性脂肪性肝病（NAFLD）被认为是MS在肝脏的表现，目前是美国仅次于丙型肝炎和酒精性肝病的第二大肝移植原因。NAFLD在肝移植受者中复发率很高，并且与其他代谢紊乱如胰岛素抵抗或糖尿病的恶化直接相关。因此，尽早识别并治疗移植患者中诸如高血压、超重、高脂血症或糖尿病等可改变的因素至关重要，从而将对患者生存的影响降至最低。此外，无类固醇方案更受青睐，免疫抑制最小化以限制对MS发展的可能影响。
