Bhati Chandra, Idowu Michael O, Sanyal Arun J, Rivera Maria, Driscoll Carolyn, Stravitz Richard T, Kohli Divyanshoo R, Matherly Scott, Puri Puneet, Gilles HoChong, Cotterell Adrian, Levy Marlon, Sterling Richard K, Luketic Velimir A, Lee Hannah, Sharma Amit, Siddiqui Mohammad Shadab
1 Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA. 2 Department of Pathology, Virginia Commonwealth University, Richmond, VA. 3 Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA. 4 Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA.
Transplantation. 2017 Aug;101(8):1867-1874. doi: 10.1097/TP.0000000000001709.
Nonalcoholic steatohepatitis (NASH), a clinically aggressive variant of nonalcoholic fatty liver disease (NAFLD), is becoming an increasingly common indication for liver transplantation (LT); however, relatively little is known regarding its clinical course post-LT. The aim of the current study is to describe disease recurrence and clinical course after LT.
All surviving patients transplanted for NASH at the authors' institution had transient elastography (TE) to evaluate hepatic steatosis and fibrosis. The charts of deceased patients were reviewed for liver biopsy to evaluate for disease recurrence. Finally, causes of mortality in these patients were evaluated.
Of the 103 patients who met criteria, 56 had TE, whereas 34 had a liver biopsy. Steatosis was detected in 49 (87.5%) of the patients who had a TE and were defined to have recurrent NAFLD. Most patients had liver stiffness measurements consistent with no fibrosis (42.9%) or F1-F2 fibrosis (30.4%). Advanced fibrosis was noted in 26.8%, whereas 5.4% had cirrhosis but were clinically compensated. In patients with liver biopsy, 88.2% had recurrent NAFLD, whereas 41.2% had recurrent NASH. Bridging fibrosis was noted in 20.6% of patients but no patients had cirrhosis. Within the cohort, 32 patients died with the leading cause of mortality cancer (25%), infectious complications (25%), and cardiovascular disease (21.9%). Only 9% of deaths were attributable to graft cirrhosis.
Recurrent NAFLD is common post-LT occurring in nearly 88% of all patients, whereas nearly a quarter of patients were noted to have advanced fibrosis.
非酒精性脂肪性肝炎（NASH）是一种临床上具有侵袭性的非酒精性脂肪性肝病（NAFLD）变体，正日益成为肝移植（LT）的常见适应证；然而，关于其肝移植后的临床病程，人们了解相对较少。本研究的目的是描述肝移植后的疾病复发情况和临床病程。
在作者所在机构接受NASH肝移植的所有存活患者均接受瞬时弹性成像（TE）以评估肝脏脂肪变性和纤维化。对已故患者的病历进行回顾，以进行肝活检评估疾病复发情况。最后，评估这些患者的死亡原因。
在符合标准的103例患者中，56例接受了TE检查，34例进行了肝活检。在接受TE检查且被定义为复发性NAFLD的患者中，49例（87.5%）检测到脂肪变性。大多数患者的肝脏硬度测量结果与无纤维化（42.9%）或F1-F2纤维化（30.4%）一致。26.8%的患者出现晚期纤维化，5.4%的患者有肝硬化但临床代偿良好。在进行肝活检的患者中，88.2%有复发性NAFLD，41.2%有复发性NASH。20.6%的患者出现桥接纤维化，但无患者有肝硬化。在该队列中，32例患者死亡，主要死亡原因是癌症（25%）、感染性并发症（25%）和心血管疾病（21.9%）。只有9%的死亡归因于移植肝肝硬化。
复发性NAFLD在肝移植后很常见，几乎在所有患者中发生率近88%，而近四分之一的患者出现晚期纤维化。
