Choudhury Ashok, Singh Satender P, Desmukh Akhil, Sahoo Bishnupriya, Eslam Mohammed
Dept of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India.
Associate Professor of Pediatrics, Consultant Pediatric Gastroenterology, Hepatology and Liver Transplant, SGT University, Gurugram, Haryana, India.
J Clin Exp Hepatol. 2024 Jul-Aug;14(4):101368. doi: 10.1016/j.jceh.2024.101368. Epub 2024 Feb 29.
Non-alcoholic steatohepatitis (NASH) is the second most frequent cause of liver transplantation following alcoholic liver disease. With longer follow-up and increased survival rates, the occurrence rate of the metabolic syndrome is increasing with time among liver transplant recipients. Reappearances of non-alcoholic fatty liver disease after transplantation, both as recurring cases and new instances, are prevalent; nonetheless, the recurrence of fibrosis is minimal. Recognizing populations at elevated risk and enhancing the management of metabolic-related conditions are crucial for maintaining a healthy transplanted organ, particularly considering the prolonged utilization of immunosuppressive treatments. Furthermore, NASH-related cirrhosis patients who had transplant are at a greater risk of cardiovascular, renal events and increased incidence of cancer, necessitating a unique care strategy. This review discusses post-transplant metabolic syndrome, risk factors, pathogenesis, diagnosis, prevention strategy, recurrent and NAFLD and customized immunosuppression.
非酒精性脂肪性肝炎（NASH）是继酒精性肝病之后第二常见的肝移植病因。随着随访时间延长和生存率提高，肝移植受者中代谢综合征的发生率随时间增加。移植后非酒精性脂肪性肝病的复发，包括复发病例和新发病例，都很普遍；然而，纤维化的复发很少。识别高危人群并加强对代谢相关疾病的管理对于维持移植器官的健康至关重要，特别是考虑到免疫抑制治疗的长期使用。此外，接受移植的NASH相关肝硬化患者发生心血管、肾脏事件的风险更高，癌症发病率增加，因此需要独特的护理策略。本综述讨论了移植后代谢综合征、危险因素、发病机制、诊断、预防策略、复发性非酒精性脂肪性肝病以及定制免疫抑制。
