Molloy R M, Komorowski R, Varma R R
Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Liver Transpl Surg. 1997 Mar;3(2):177-8. doi: 10.1002/lt.500030212.
Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis and lead to liver failure. Histologically, NASH is often indistinguishable from liver disease caused by alcohol use; the cause of NASH remains unknown. A subgroup of patients with NASH eventually develops fibrosis and/or cirrhosis, and in many cases, transplantation is performed for end-stage liver disease attributed to steatohepatitis in patients who do not consume alcohol. The patient described received a transplant for end-stage liver disease secondary to NASH with cirrhosis. Postoperatively she did well, with a bout of mild rejection treated successfully at week 9 with prompt normalization of liver tests. Weight and glycemic control were optimized, and steroid therapy was minimized as safely as possible. Repeat liver biopsy at week 66, however, for persistent mild elevation of alkaline phosphatase and gamma-glutamyl-transferase surprisingly revealed the "recurrence" of NASH. Subsequent biopsy revealed NASH with cirrhosis by week 76 after transplantation. Subsequent biopsy at week 87 has confirmed cirrhosis. The patient does not consume alcohol. It is believed to be the first reporting of such a case.
非酒精性脂肪性肝炎（NASH）可能进展为肝硬化并导致肝衰竭。从组织学上看，NASH通常与酒精所致肝病难以区分；NASH的病因尚不清楚。一部分NASH患者最终会发展为纤维化和/或肝硬化，在许多情况下，会为不饮酒但因脂肪性肝炎导致终末期肝病的患者进行肝移植。所述患者因NASH合并肝硬化导致的终末期肝病接受了肝移植。术后她恢复良好，在第9周时出现了一次轻度排斥反应，经及时治疗，肝功能检查迅速恢复正常。体重和血糖控制得到优化，类固醇治疗尽可能安全地减至最低剂量。然而，在第66周时，因碱性磷酸酶和γ-谷氨酰转移酶持续轻度升高进行的重复肝活检意外发现了NASH的“复发”。随后的活检显示，移植后第76周出现了NASH合并肝硬化。第87周的后续活检证实为肝硬化。该患者不饮酒。据信这是此类病例的首次报道。
