Maiwall Rakhi, Gupta Manasvi
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Internal Medicine, University of Connecticut School of Medicine, Hartford, CT, USA.
Transl Gastroenterol Hepatol. 2020 Apr 5;5:18. doi: 10.21037/tgh.2019.10.11. eCollection 2020.
Non-alcoholic fatty liver disease (NAFLD) is currently the most common etiology of chronic liver disease (CLD) caused by an accumulation of fat in the liver and globally is the leading indication of liver transplantation. Emerging data has recognized an increased association of NAFLD with risk of other metabolic liver diseases like type 2 diabetes mellitus, chronic kidney disease (CKD) and cardiovascular diseases. Pathophysiologically, NAFLD patients have a state of low-grade systemic inflammation, insulin resistance and atherogenic dyslipidemia which causes renal dysfunction. Patients with NAFLD cirrhosis awaiting liver transplant (LT) face unique challenges and have a significantly higher requirement of simultaneous-liver-kidney transplant as compared to other etiologies. Further, NAFLD not only recurs but also occurs as a de novo manifestation post-LT. There is also a significantly higher risk of waiting list stagnation and dropouts due to burdensome cardiometabolic disorders in NAFLD patients. The current review aims to understand the prevalence and pathogenetic basis of renal dysfunction in NAFLD. Additionally, the review describes the choice of immunosuppression protocols and use of intraoperative renal replacement therapy in context of intra and post-operative renal dysfunction in NAFLD patients. Prospective controlled trials focusing on NAFLD and development of CKD are needed to assess the existence of a causal and/or a bidirectional relationship between NAFLD and CKD.
非酒精性脂肪性肝病（NAFLD）是目前由肝脏脂肪堆积引起的慢性肝病（CLD）的最常见病因，在全球范围内是肝移植的主要指征。新出现的数据表明，NAFLD与其他代谢性肝病（如2型糖尿病、慢性肾脏病（CKD）和心血管疾病）的风险增加有关。在病理生理学上，NAFLD患者存在低度全身炎症、胰岛素抵抗和致动脉粥样硬化性血脂异常，这些会导致肾功能障碍。等待肝移植（LT）的NAFLD肝硬化患者面临独特的挑战，与其他病因相比，他们对肝肾联合移植的需求显著更高。此外，NAFLD不仅会复发，还会在LT后作为新发表现出现。由于NAFLD患者存在负担沉重的心脏代谢紊乱，等待名单停滞和退出的风险也显著更高。本综述旨在了解NAFLD患者肾功能障碍的患病率和发病机制基础。此外，该综述还描述了在NAFLD患者术中及术后出现肾功能障碍的情况下免疫抑制方案的选择和术中肾脏替代治疗的使用。需要开展针对NAFLD和CKD发展的前瞻性对照试验，以评估NAFLD与CKD之间是否存在因果关系和/或双向关系。
