PDF(Pubmed)
Abstract：
The development of steatotic liver disease after liver transplant (LT) is widely described, and epidemiological data have revealed an increased incidence in recent times. Its evolution runs from simple steatosis to steatohepatitis and, in a small proportion of patients, to significant fibrosis and cirrhosis. Apparently, post-LT steatotic disease has no impact on the recipient\'s overall survival; however, a higher cardiovascular and malignancy burden has been reported. Many donors\' and recipients\' risk factors have been associated with this occurrence, although the recipient-related ones seem of greater impact. Particularly, pre- and post-LT metabolic alterations are strictly associated with steatotic graft disease, sharing common pathophysiologic mechanisms that converge on insulin resistance. Other relevant risk factors include genetic variants, sex, age, baseline liver diseases, and immunosuppressive drugs. Diagnostic evaluation relies on liver biopsy, although non-invasive methods are being increasingly used to detect and monitor both steatosis and fibrosis stages. Management requires a multifaceted approach focusing on lifestyle modifications, the optimization of immunosuppressive therapy, and the management of metabolic complications. This review aims to synthesize the current knowledge of post-LT steatotic liver disease, focusing on the recent definition of metabolic-dysfunction-associated steatotic liver disease (MASLD) and its metabolic and multisystemic concerns.
摘要：
肝移植（LT）后脂肪变性肝病的发展被广泛描述，流行病学数据显示，近年来发病率有所增加。它的演变从简单的脂肪变性到脂肪性肝炎，在一小部分患者中，严重的纤维化和肝硬化。显然,肝移植后脂肪变性疾病对接受者的总体生存率没有影响；然而，据报道，心血管和恶性肿瘤负担较高。许多捐赠者和接受者的危险因素与这种情况有关，尽管与接受者相关的影响似乎更大。特别是,LT前后代谢改变与脂肪移植病密切相关，共享共同的病理生理机制，集中于胰岛素抵抗。其他相关风险因素包括遗传变异，性别,年龄,基线肝脏疾病，和免疫抑制药物。诊断评估依赖于肝活检，尽管非侵入性方法越来越多地用于检测和监测脂肪变性和纤维化阶段。管理需要多方面的方法，注重生活方式的改变，优化免疫抑制治疗，以及代谢并发症的管理。这篇综述旨在综合肝移植后脂肪变性肝病的最新知识，关注代谢功能障碍相关脂肪变性肝病（MASLD）的最新定义及其代谢和多系统问题。
