Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village
Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village
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非酒精性脂肪性肝炎患者肝移植的多学科方法：需要一个村庄
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
N. Alkhouri
中科院分区：
文献类型：
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作者：
E. Tsai;R. Patnaik;N. Alkhouri
摘要非酒精性脂肪性肝病（NAFLD）是西方国家肝病的主要原因，其侵袭性形式非酒精性脂肪性肝炎（NASH）是肝硬化和终末期肝病的主要原因。NASH的新肝移植等待名单登记者的总数继续快速增加，使NASH成为肝移植的第二大最常见适应症。与其他病因的接受者相比，NASH患者通常具有更高的肥胖、糖尿病、血脂异常、高血压、肾脏疾病和心脏疾病的发生率。这些合并症中的许多与术前风险增加以及短期和长期并发症独立相关。这些特殊风险因素的存在需要早期发现，医疗优化和仔细的术前护理。减肥手术是一种有效的减肥策略，并最终减少肥胖相关的医疗并发症。在选择的患者中，减肥手术-在肝移植之前，期间或之后-可能有助于改善移植后的结果。NAFLD/NASH可以在肝移植后出现，并且作为复发性或新发疾病发生。移植后NAFLD发生在代谢综合征、免疫抑制剂使用和遗传决定因素的背景下。未来的研究和努力应该集中在优化医疗管理策略，以进一步改善NAFLD患者的移植结局。
Abstract Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in Western countries, and its aggressive form, nonalcoholic steatohepatitis (NASH), is a leading cause of cirrhosis and end-stage liver disease. The total number of new liver transplantation waitlist registrants with NASH continues to increase rapidly, making NASH the second most common indication for liver transplantation. Compared with recipients for other etiologies, patients with NASH often have higher rates of obesity, diabetes, dyslipidemia, hypertension, kidney disease, and cardiac disease. Many of these medical comorbidities are independently associated with increased preoperative risk and both short- and long-term complications. The presence of these particular risk factors necessitates the need for early detection, medical optimization, and careful preoperative care. Bariatric surgery is an effective strategy for weight loss and ultimately reducing obesity-related medical complications. In select patients, bariatric surgery—before, during, or after liver transplantation—may be useful to help improve posttransplant outcomes. NAFLD/NASH can present after liver transplantation and occurs as either recurrent or de novo disease. Posttransplant NAFLD occurs in the setting of metabolic syndrome, immunosuppression use, and genetic determinants. Future studies and efforts should focus on optimizing medical management strategies to further improve transplant outcomes in patients with NAFLD.
影响因子：
25.7
作者：
Pais R;Barritt AS 4th;Calmus Y;Scatton O;Runge T;Lebray P;Poynard T;Ratziu V;Conti F
通讯作者：
Conti F
隐源性肝硬化、酒精、丙型肝炎和胆汁淤积性肝病肝移植后比较同种异体移植组织学。
影响因子：
6.2
作者：
Maor-Kendler,Y;Batts,KP;Burgart,LJ;Wiesner,RH;Krom,RA;Rosen,CB;Charlton,MR
通讯作者：
Charlton,MR
影响因子：
29.4
作者：
Charlton, Michael R.;Burns, Justin M.;Dierkhising, Ross A.
通讯作者：
Dierkhising, Ross A.