Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis
Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis
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DOI：
10.1053/jlts.2001.23011
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发表时间：
2001-04-01
影响因子：
4.6
通讯作者：
Sanyal, AJ
中科院分区：
文献类型：
--
作者：
Contos, MJ;Cales, W;Sanyal, AJ
许多隐源性肝硬化受试者存在潜在的非酒精性脂肪性肝炎（NASH），原位肝移植（奥尔特）后NASH相关隐源性肝硬化的自然史尚未明确。对接受奥尔特的NASH相关肝硬化临床组织学表型患者进行了初步回顾性研究。将数据与2组年龄和体重匹配的对照组进行比较，对照组为（1）原发性胆汁性肝硬化或原发性硬化性胆管炎或（2）酒精性肝病。奥尔特后，所有患者均采用标准免疫抑制方案进行管理。肝活检在奥尔特后6个月和12个月进行，此后间隔1- 2年，以及当肝酶水平升高到足以保证诊断性活检时进行。纳入27例隐源性肝硬化和NASH临床组织学表型的受试者和3例在奥尔特前长期诊断为NASH的患者。30天的围手术期死亡率为1/30例。在中位随访3.5 ± 2.7年期间，另外2例患者死于败血症。移植物脂肪变性的风险随时间增加，5年时接近100%，而对照组脂肪变性的发生率仅为约25%（P <0.009，对数秩检验）。在多变量分析中，只有累积类固醇剂量与发生同种异体移植物脂肪变性的时间相关，3例患者发生了从肝脂肪变性到脂肪性肝炎的组织学进展，其中1例患者发生了进行性纤维化。4例患者发生了至少1次急性细胞排斥反应;然而，没有患者发生慢性排斥反应或移植物衰竭。总之，具有NASH相关肝硬化表型的患者在原位肝奥尔特后经常发生非酒精性脂肪肝。尽管疾病的组织学复发频繁，但临床结果与其他接受奥尔特的患者组相似。
Many subjects with cryptogenic cirrhosis have underlying nonalcoholic steatohepatitis (NASH), The natural history of NASH-related cryptogenic cirrhosis after orthotopic liver transplantation (OLT) is not well defined. A primarily retrospective study of patients with the clinical histological phenotype of NASH-related cirrhosis undergoing OLT was performed. Data were compared with 2 sets of age- and weight-matched controls with (1) primary biliary cirrhosis or primary sclerosing cholangitis or (2) alcoholic liver disease. After OLT, all patients were managed by a standard immunosuppressive protocol. Liver biopsies were performed at 6 and 12 months after OLT and at 1- to 2-year intervals thereafter, as well as when liver enzyme levels were elevated enough to warrant diagnostic biopsy. Twenty-seven subjects with cryptogenic cirrhosis and a clinical histological phenotype of NASH and 3 patients with a long-standing diagnosis of NASH before OLT were included. The 30-day perioperative mortality was 1 in 30 patients, During a median follow-up of 3.5 +/- 2.7 years, 2 additional patients died of sepsis, There was a time-dependent increase in the risk for allograft steatosis that approached 100% by 5 years compared with only an approximately 25% incidence of steatosis in the control groups (P < .009, log-rank test). On multivariate analysis, only the cumulative steroid dose correlated with time to development of allograft steatosis, Three patients developed histological progression from hepatic steatosis to steatohepatitis, Of these, 1 patient developed progressive fibrosis. Four patients experienced at least 1 episode of acute cellular rejection; however, no patient developed chronic rejection or graft failure. In conclusion, nonalcoholic fatty liver disease occurs frequently after OLT in patients with the phenotype of NASH-related cirrhosis. Despite the frequent histological recurrence of disease, clinical outcomes are similar to those of other groups of patients undergoing OLT.