Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Gastroenterology Unit, IRCCS "Saverio De Bellis", Castellana Grotte, BA, Italy.
Aliment Pharmacol Ther. 2018 Mar;47(6):704-714. doi: 10.1111/apt.14521. Epub 2018 Jan 22.
De novo non-alcoholic fatty liver disease (NAFLD) in liver-transplanted patients for cirrhosis not due to non-alcoholic steatohepatitis (NASH) is becoming a growing phenomenon.
We performed a systematic review and evaluated the prevalence of this event and possible associated factors.
A literature search in medical databases (PubMed, MEDLINE/OVIDSP, Science Direct and EMBASE) was performed in March 2017. Relevant publications were identified in most important databases. We estimated the pooled prevalence of NAFLD and NASH in patients with liver transplant. The data have been expressed as proportions/percentages, and 95% confidence intervals (CI) were calculated, using the inverse variance method. Odd ratios (OR) and 95% confidence intervals (95% CI) were estimated.
Twelve studies were selected, enrolling 2166 subjects overall undergoing post-liver transplant biopsy. The pooled weighted prevalence of de novo NAFLD was 26% (95% CI 20%-31%). The pooled weighted prevalence of NASH was 2% (95% CI 0%-3%). The highest prevalences of de novo NAFLD were found for patients transplanted for alcoholic cirrhosis (37%) and cryptogenic cirrhosis (35%) and for patients taking tacrolimus (26%). Tacrolimus showed a risk of NAFLD similar to ciclosporin (OR = 1.02, 95% CI 0.3-3.51).
Patients undergoing liver transplant are more prone to experience diabetes, hypertension or dyslipidaemia, and NAFLD may be an important element in this context. In this study, we show how the prevalence of NASH tends to remain significant and similar to the general population. Moreover, this study suggests a possible association with specific transplant indications. Further studies are required to confirm these findings.
非酒精性脂肪性肝病（NAFLD）在非酒精性脂肪性肝炎（NASH）以外原因导致肝硬化的肝移植患者中不断增加。
我们进行了系统评价，评估了这种现象的发生率和可能相关的因素。
我们于 2017 年 3 月在医学数据库（PubMed、MEDLINE/OVIDSP、Science Direct 和 EMBASE）中进行了文献检索。在大多数重要数据库中都确定了相关的出版物。我们估计了肝移植患者中 NAFLD 和 NASH 的总体发生率。数据以比例/百分比表示，并使用Inverse Variance 方法计算了 95%置信区间（CI）。计算了比值比（OR）和 95%置信区间（95%CI）。
共纳入 12 项研究，共纳入 2166 例接受肝移植后活检的患者。新发非酒精性脂肪性肝病的总体加权发生率为 26%（95%CI 20%-31%）。新发 NASH 的加权发生率为 2%（95%CI 0%-3%）。新发非酒精性脂肪性肝病发生率最高的患者为酒精性肝硬化（37%）和隐匿性肝硬化（35%）患者以及接受他克莫司治疗的患者（26%）。他克莫司发生非酒精性脂肪性肝病的风险与环孢素相似（OR=1.02，95%CI 0.3-3.51）。
接受肝移植的患者更容易发生糖尿病、高血压或血脂异常，非酒精性脂肪性肝病可能是这方面的一个重要因素。在本研究中，我们展示了 NASH 的发生率如何保持显著并与普通人群相似。此外，本研究提示与特定的移植适应证可能存在关联。需要进一步的研究来证实这些发现。
