免疫抑制方案对肝移植术后代谢功能障碍相关脂肪性肝病的影响。
Effect of Immunosuppressive Regimens on Metabolic Dysfunction-associated Fatty Liver Disease Following Liver Transplantation.
作者信息
Kang Jing, Zhu Ji-Qiao, Wang Yan, He Qiang
机构信息
Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Organ Transplant Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
出版信息
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102387. doi: 10.1016/j.jceh.2024.102387. Epub 2024 Aug 6.
BACKGROUND
Metabolic dysfunction-associated fatty liver disease has been linked to negative outcomes in patients with end-stage liver disease following liver transplantation. However, the influence of immunosuppressive regimens on it has not been explored.
METHODS
A retrospective analysis was conducted using the preoperative and postoperative data from patients with end-stage liver disease. The study compared three different groups: tacrolimus-based group, sirolimus-based group, and combined tacrolimus- and sirolimus-based regimens. Binary logistic regression analysis was employed to identify risk factors for metabolic dysfunction-associated fatty liver disease.
RESULTS
A total of 171 patients participated in the study, consisting of 127 males and 44 females, with a mean age of 49.6 years. The prevalence of posttransplant metabolic dysfunction-associated fatty liver disease was 29.23%. Among the three groups, there were 111 liver transplant recipients in the tacrolimus-based group, 28 in the sirolimus-based group, and 32 in the combination group. A statistically significant difference was observed in the incidence of metabolic dysfunction-associated fatty liver disease ( < 0.05), whereas the other preoperative and postoperative parameters showed no significant differences. Multivariate analysis revealed that a low-calorie diet (95% confidence intervals: 0.15-0.90, = 0.021) and a combination of tacrolimus- and sirolimus-based immunosuppressive regimen (95% confidence intervals: 1.01-2.77, = 0.046) were associated with lower risk of posttransplant metabolic dysfunction-associated fatty liver disease.
CONCLUSIONS
Our study indicates that implementing a low-calorie diet and utilizing a combination of tacrolimus- and sirolimus-based immunosuppressive regimen can effectively lower the risk of posttransplant metabolic dysfunction-associated fatty liver disease following liver transplantation.
背景
代谢功能障碍相关脂肪性肝病与肝移植术后终末期肝病患者的不良预后相关。然而，免疫抑制方案对其影响尚未得到探讨。
方法
采用终末期肝病患者术前和术后数据进行回顾性分析。该研究比较了三个不同组：他克莫司组、西罗莫司组和他克莫司与西罗莫司联合方案组。采用二元逻辑回归分析确定代谢功能障碍相关脂肪性肝病的危险因素。
结果
共有171例患者参与研究，其中男性127例，女性44例，平均年龄49.6岁。移植后代谢功能障碍相关脂肪性肝病的患病率为29.23%。三组中，他克莫司组有111例肝移植受者，西罗莫司组有28例，联合组有32例。代谢功能障碍相关脂肪性肝病的发生率存在统计学显著差异（<0.05），而其他术前和术后参数无显著差异。多变量分析显示，低热量饮食（95%置信区间：0.15 - 0.90，=0.021）和他克莫司与西罗莫司联合免疫抑制方案（95%置信区间：
Zotero 插件