Metabolic Syndrome Unit, University of Modena, Modena, Italy.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
Nat Rev Endocrinol. 2022 Oct;18(10):638-650. doi: 10.1038/s41574-022-00711-5. Epub 2022 Jul 15.
The rising tide of non-alcoholic fatty liver disease (NAFLD) associated with the obesity epidemic is a major health concern worldwide. NAFLD - specifically its more advanced form, non-alcoholic steatohepatitis (NASH)-related cirrhosis - is now the fastest growing indication for liver transplantation in the USA and Europe. Although the short-term and mid-term overall survival rates of patients who receive a liver transplant for NASH-related cirrhosis are essentially similar to those of patients who receive a transplant for other liver indications, recipients with NASH-related cirrhosis have an increased risk of waiting-list mortality and of developing recurrent liver disease and cardiometabolic complications in the longer term after liver transplantation. This Review provides a brief overview of the epidemiology of NAFLD and NASH and the occurrence of NAFLD or NASH in patients after liver transplantation for NASH and other liver indications. It also discusses the putative metabolic mechanisms underlying the emergence of NAFLD or NASH after liver transplantation as well as optimal therapeutic approaches for recipients of liver transplants, including the management of cardiometabolic comorbidities, tailored immunosuppression, lifestyle changes and pharmacotherapy for NAFLD.
随着肥胖症的流行，非酒精性脂肪性肝病（NAFLD）的发病率不断上升，成为全球范围内的一个主要健康问题。NAFLD——特别是其更严重的形式，非酒精性脂肪性肝炎（NASH）相关肝硬化——现在是美国和欧洲肝移植增长最快的适应症。尽管接受 NASH 相关肝硬化肝移植的患者的短期和中期总体生存率与因其他肝脏适应症接受肝移植的患者基本相似，但 NASH 相关肝硬化患者在肝移植后等待名单上的死亡率以及在更长期内发生复发性肝病和心血管代谢并发症的风险增加。这篇综述简要概述了 NAFLD 和 NASH 的流行病学，以及 NASH 和其他肝脏适应症患者在接受肝移植后发生 NAFLD 或 NASH 的情况。它还讨论了肝移植后出现 NAFLD 或 NASH 的潜在代谢机制，以及肝移植受者的最佳治疗方法，包括心血管代谢合并症的管理、量身定制的免疫抑制、生活方式改变和 NAFLD 的药物治疗。
