Choudhary Narendra S, Saraf Neeraj, Dhampalwar Swapnil, Mishra Saurabh, Gautam Dheeraj, Lipi Lipika, Rastogi Amit, Bhangui Prashant, Chaudhary Rohan J, Gupta Ankur, Yadav Kamal, Soin Arvinder S
Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India.
Department of Pathology, Medanta The Medicity, Gurgaon, Delhi (NCR), India.
J Clin Exp Hepatol. 2022 Sep-Oct;12(5):1328-1332. doi: 10.1016/j.jceh.2022.04.012. Epub 2022 May 5.
Recurrent or de novo nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common after liver transplantation (LT) and may be associated with rapid progression to fibrosis; however, there is limited data in this regard after living donor liver transplantation (LDLT).
This is a retrospective study at a high volume LDLT center of all liver biopsies performed in patients with post-transplant NAFLD diagnosed on ultrasound of the abdomen. Liver biopsy was indicated for raised transaminases and/or high liver stiffness on TE. The association between these prebiopsy parameters and inflammation and fibrosis on histology was analyzed. Data are shown as mean ± standard deviation or median (25-75 interquartile range).
The study cohort consisted of 31 males and 3 females, aged 43 ± 10 years. The LT to liver biopsy interval was 44 (28-68) months. The prebiopsy AST and ALT were 71 (38-119) and 66 (50-156), respectively. The histology suggested no nonalcoholic steatohepatitis (NASH) in 7 (20%), borderline NASH in 15 (44%), and NASH in 12 (35%) patients. A total of 15 patients (44%) had stage 1 or stage 2 fibrosis. The proportion of patients having fibrosis was significantly higher in patients with NASH (83%) compared to patients with borderline NASH (33%) or no NASH (none had fibrosis, = 0.001). Among 18 patients who underwent TE (on FibroScan), liver stiffness was significantly higher in patients with fibrosis [18.1 (9.7-22.5)] than in those without fibrosis [9.7 (4.0-12.7); = 0.043].
Over a third of the LDLT recipients with post-transplant NAFLD developed NASH, and nearly half, borderline NASH 3-5 years after transplant. Most with established NASH also had fibrosis on histology. Prevention of risk factors and early diagnosis is warranted in these patients.
复发性或新发非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）在肝移植（LT）后很常见，可能与肝纤维化的快速进展有关；然而，关于活体肝移植（LDLT）后这方面的数据有限。
这是一项在大容量LDLT中心进行的回顾性研究，研究对象为腹部超声诊断为移植后NAFLD患者的所有肝脏活检。肝活检适用于转氨酶升高和/或TE检测肝硬度升高的情况。分析了这些活检前参数与组织学炎症和纤维化之间的关联。数据以平均值±标准差或中位数（四分位数间距25 - 75）表示。
研究队列包括31名男性和3名女性，年龄43±10岁。肝移植至肝活检的间隔时间为44（28 - 68）个月。活检前AST和ALT分别为71（38 - 119）和66（50 - 156）。组织学显示，7例（20%）患者无非酒精性脂肪性肝炎（NASH），15例（44%）为临界NASH，12例（35%）为NASH。共有15例患者（44%）有1期或2期纤维化。与临界NASH患者（33%）或无NASH患者（均无纤维化，P = 0.001）相比，NASH患者中出现纤维化的比例显著更高。在18例接受TE（FibroScan检测）的患者中，有纤维化患者的肝脏硬度[18.1（9.7 - 22.5）]显著高于无纤维化患者[9.7（4.0 - 12.7）；P = 0.043]。
超过三分之一的移植后NAFLD的LDLT受者发生了NASH，近一半为临界NASH，均发生在移植后3至5年。大多数确诊为NASH的患者组织学上也有纤维化。对这些患者进行危险因素预防和早期诊断很有必要。
