Non-Alcoholic Fatty Liver Disease in Liver Transplant Recipients: Another Story of "Seed and Soil"
Non-Alcoholic Fatty Liver Disease in Liver Transplant Recipients: Another Story of "Seed and Soil"
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DOI：
10.1038/ajg.2009.717
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发表时间：
2010-03-01
影响因子：
9.8
通讯作者：
Hadengue, Antoine
中科院分区：
文献类型：
--
作者：
Dumortier, Jerome;Giostra, Emiliano;Hadengue, Antoine
目的：脂肪肝病是肝移植（LT）的潜在长期并发症。因此，我们的目的是确定大量成人 LT 后患者中肝脂肪变性的患病率和危险因素。 方法：我们评估了 LT 后随访期间肝活检诊断为脂肪变性的患者的临床、生物学、组织学和进化特征。通过单变量和多变量分析对危险因素进行分析。结果：总共获得了来自 599 名患者的 1,596 份肝活检样本。 178 名患者出现复发性肝病。其余 421 名患者中的 131 名（31.1%）（51.1% 肝脏检查正常）进行了脂肪变性的组织学诊断：53% 为 1 级、31% 为 2 级、16% 为 3 级脂肪变性。 38 名患者 (29.0%) 存在窦周纤维化。 5 名患者（3.8%）的组织学病变符合非酒精性脂肪性肝炎（NASH）的诊断。随访结束时，3例患者（2.25%）出现肝硬化或广泛纤维化。多变量分析显示，7个因素（LT后肥胖、以他克莫司为基础的治疗方案、糖尿病、高脂血症、动脉高血压、作为LT主要指征的酒精性肝硬化和移植肝移植前脂肪变性）是LT后脂肪变性的危险因素。当存在零、一、二、三、四、五和六个因素时，脂肪变性发生率分别为 6.0%、12.0%、22.1%、29.9%、65.5%、81.5% 和 100.0%。 结论：肝脏脂肪变性是 LT 常见的晚期并发症。它的发展取决于宿主和移植物因素的结合。因此，LT 是研究肝脏脂肪变性的自然史和决定因素的一个有趣的模型。
OBJECTIVES: Fatty liver disease is a potential long-term complication of liver transplantation (LT). We therefore aimed to determine the prevalence and risk factors of liver steatosis in a large population of adult post-LT patients.METHODS: We evaluated the clinical, biological, histological, and evolutive features of patients with a diagnosis of steatosis made at liver biopsy examination during post-LT follow-up. Risk factors were analyzed by univariate and multivariate analysis.RESULTS: In total, 1,596 liver biopsies from 599 patients were available. Recurrent liver disease was present in 178 patients. A histological diagnosis of steatosis was made in 131 (31.1%) of the remaining 421 patients (51.1% had normal liver tests): 53% had grade 1, 31% grade 2, and 16% grade 3 steatosis. Perisinusoidal fibrosis was present in 38 patients (29.0%). Histological lesions were consistent with the diagnosis of non-alcoholic steatohepatitis (NASH) in 5 patients (3.8%). At the end of follow-up, cirrhosis or extensive fibrosis was observed in 3 patients (2.25%). Multivariate analysis showed that seven factors (post-LT obesity, tacrolimus-based regimen, diabetes mellitus, hyperlipidemia, arterial hypertension, alcoholic cirrhosis as primary indication for LT, and pre-transplant liver graft steatosis) were risk factors for post-LT steatosis. When zero, one, two, three, four, five, and six factors were present, steatosis occurred in 6.0, 12.0, 22.1, 29.9, 65.5, 81.5, and 100.0%, respectively.CONCLUSIONS: Liver steatosis is a frequent late complication of LT; its development depends on a combination of host and graft factors. LT is therefore an interesting model to study the natural history and the determinants of liver steatosis.