Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Nursing, Osaka University Hospital, Osaka, Japan.
Transpl Int. 2021 Nov;34(11):2238-2246. doi: 10.1111/tri.14005. Epub 2021 Sep 17.
We retrospectively reviewed 220 living liver donors, with a focus on the development of postoperative fatty liver. Data regarding demographics, comorbidities, imaging tests, operations and biopsies were obtained from medical records. We used unenhanced CT and USG to diagnose fatty liver. Donor candidates with fatty liver underwent weight loss intervention until imaging tests no longer demonstrated any features of fatty liver. Among 220 donors, 61 were diagnosed with preoperative fatty liver. The mean BMI of these 61 donors significantly decreased from 24.9 at the first visit to 23.6 kg/m immediately before surgery (P = 0.0386). A multivariate analysis revealed the following significant risk factors for postoperative fatty liver: male sex (P = 0.0033), BMI immediately before surgery (P = 0.0028) and a history of treatment for preoperative fatty liver (P = 0.0231). Postoperative fatty liver was often refractory to weight loss intervention. No improvement was observed in 14 of the 32 donors who had been diagnosed with fatty liver postoperatively, and one of the 14 donors even developed NASH. In conclusion, special attention should be paid to prevent fatty liver after surgery in male donors who show a high BMI immediately before surgery and with a history of treatment for preoperative fatty liver, and lifelong follow-up is recommended.
我们回顾性分析了 220 例活体肝移植供者，重点关注术后脂肪肝的发生情况。从病历中获取了人口统计学、合并症、影像学检查、手术和肝活检等数据。我们使用未增强 CT 和 USG 诊断脂肪肝。有脂肪肝的供者候选者在影像学检查不再显示任何脂肪肝特征后进行减肥干预。在 220 名供者中，有 61 名术前诊断为脂肪肝。这些 61 名供者的平均 BMI 从首次就诊时的 24.9 显著下降至手术前即刻的 23.6kg/m²（P=0.0386）。多因素分析显示术后脂肪肝的以下显著危险因素：男性（P=0.0033）、手术前即刻 BMI（P=0.0028）和术前脂肪肝治疗史（P=0.0231）。术后脂肪肝常对减肥干预有抵抗。在术后诊断为脂肪肝的 32 名供者中，有 14 名没有改善，其中 1 名甚至发展为 NASH。总之，对于术前 BMI 较高且有术前脂肪肝治疗史的男性供者，术后应特别注意预防脂肪肝，并建议进行终身随访。
