Ahmed Zunirah, Khan Muhammad Ali, Vazquez-Montesino Luis Miguel, Ahmed Aijaz
Houston Methodist, Houston, TX, USA.
Division of Gastroenterology and Hepatology, University of Alabama Birmingham, AL, USA.
Transl Gastroenterol Hepatol. 2022 Jul 25;7:25. doi: 10.21037/tgh-2020-14. eCollection 2022.
The obesity epidemic has profoundly impacted the epidemiology and trends of liver disease. In the current era, non-alcoholic fatty liver disease (NAFLD) progressing to non-alcoholic steatohepatitis (NASH) has emerged as the second leading indication for liver transplant (LT) and has been associated with the rising rates of hepatocellular carcinoma (HCC) with and without underlying cirrhosis. Obesity has been associated with poor post-transplant outcomes including lower patient and graft survival; higher risk of post-operative metabolic complications; poor wound healing; and higher infection rates. Bariatric surgery is currently the most effective management of morbid obesity and has been offered to patients both in the pre and post LT setting. The techniques attempted in LT recipients most commonly include sleeve gastrectomy (SG), gastric bypass surgery with few cases of gastric banding and biliopancreatic diversion. However, there is lack of evidence-based data on the optimal management for patients with obesity and who are liver transplant candidates and/or recipients. In the following discussion, we present the highlights from a review of the literature.
肥胖流行已对肝脏疾病的流行病学和趋势产生了深远影响。在当今时代，非酒精性脂肪性肝病（NAFLD）进展为非酒精性脂肪性肝炎（NASH）已成为肝移植（LT）的第二大主要适应证，并且与肝细胞癌（HCC）发生率的上升相关，无论是否伴有潜在肝硬化。肥胖与移植后不良结局相关，包括患者和移植物存活率较低；术后代谢并发症风险较高；伤口愈合不良；以及感染率较高。减重手术是目前治疗病态肥胖最有效的方法，已在肝移植术前和术后为患者提供。在肝移植受者中尝试的技术最常见的包括袖状胃切除术（SG）、胃旁路手术，胃束带术和胆胰转流术的病例较少。然而，对于肥胖的肝移植候选者和/或受者的最佳管理，缺乏循证数据。在以下讨论中，我们展示了文献综述的要点。
