Tennova Cleveland Hospital, 2305 Chambliss Ave NW, Cleveland, TN, 37311, USA.
Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Dig Dis Sci. 2019 Dec;64(12):3413-3430. doi: 10.1007/s10620-019-05716-1. Epub 2019 Jul 16.
Nonalcoholic steatohepatitis is the fastest-growing indication for the liver transplant and a leading cause of hepatocellular carcinoma among patients listed for liver transplantation in the USA. Post-transplant nonalcoholic hepatic steatosis and steatohepatitis are frequent complications of liver transplantation. Nonalcoholic steatohepatitis poses a significant challenge in both pre- and post-transplant period due to its association with metabolic syndrome, coronary artery disease, chronic kidney disease, and obstructive sleep apnea. While optimal therapy is not yet available in the post-liver transplant setting, lifestyle interventions continue to remain as the mainstay of therapy for post-transplant nonalcoholic steatohepatitis. Early recognition with protocol biopsies and noninvasive modalities, along with modification of known risk factors, are the most effective methods to curtail the progression of nonalcoholic steatohepatitis in the absence of FDA-approved pharmacologic therapy.
非酒精性脂肪性肝炎是肝移植增长最快的适应证，也是美国肝移植患者中肝细胞癌的主要原因。肝移植后非酒精性肝脂肪变性和脂肪性肝炎是肝移植后的常见并发症。由于非酒精性脂肪性肝炎与代谢综合征、冠状动脉疾病、慢性肾脏病和阻塞性睡眠呼吸暂停有关，因此在移植前和移植后都存在很大的挑战。虽然肝移植后还没有最佳的治疗方法，但生活方式干预仍然是肝移植后非酒精性脂肪性肝炎治疗的主要方法。通过方案活检和非侵入性方法早期识别，并改变已知的风险因素，是在没有获得 FDA 批准的药物治疗的情况下遏制非酒精性脂肪性肝炎进展的最有效方法。
