诊断 MAFLD 在接受酒精相关性肝病肝移植病人中的效用和预测价值。
Utility and prognostic value of diagnosing MAFLD in patients undergoing liver transplantation for alcohol-related liver disease.
发表日期：2023 Mar 20
作者：
Benedict T K Vanlerberghe, Hannah van Malenstein, Mauricio Sainz-Bariga, Ina Jochmans, David Cassiman, Diethard Monbaliu, Schalk van der Merwe, Jacques Pirenne, Frederik Nevens, Jef Verbeek
来源：
DIABETES & METABOLISM
摘要：
最近，代谢功能障碍相关脂肪肝病（MAFLD）被提出，用来替代非酒精性脂肪肝病（NAFLD）。这个概念可以诊断与代谢功能障碍相关的肝脏疾病，包括酒精相关肝病（ALD）患者。这是肝移植（LTx）的主要适应症。我们评估了在接受LTx的ALD患者中MAFLD的患病率及其在LTx后转归方面的预测价值。我们回顾性分析了我中心1990年至2020年8月间接受LTx的所有ALD患者。基于LTx时存在或有肝脏脂肪变性和BMI > 25或II型糖尿病或≥ 2个代谢风险异常来诊断MAFLD。通过Cox回归分析总体生存率和再发性肝和心血管事件的危险因素。371名纳入研究的ALD患者中，255名（68.7％）在LTx时伴随着MAFLD。LTx后中位随访时间为72个月（IQR：34.50-122）。拥有ALD-MAFLD的患者在LTx时年龄更大（p = .001），更多为男性（p < .001），更常见肝细胞癌（p < .001）。未找到围手术期死亡和总体生存差异。无论是否出现酒精复发，ALD-MAFLD患者都有复发性肝脏脂肪变性的增加风险，但没有心血管事件的附加风险。LTx时同时存在MAFLD与ALD的患者具有明显的患者特点，并且是再发性肝脏脂肪变性的独立危险因素。在ALD患者中使用MAFLD标准可能会增加在LTx前后特定肝脏和全身代谢异常的认识和治疗。© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD). This concept enables diagnosing liver disease associated with metabolic dysfunction in patients with alcohol-related liver disease (ALD), a main indication for liver transplantation (LTx). We assessed MAFLD prevalence in ALD patients undergoing LTx and its prognostic value on post-LTx outcomes.We retrospectively analyzed all ALD patients transplanted at our center between 1990 and August 2020. MAFLD was diagnosed based on the presence or history of hepatic steatosis and a BMI > 25 or type II diabetes or ≥ 2 metabolic risk abnormalities at LTx. Overall survival and risk factors for recurrent liver and cardiovascular events were analyzed by Cox regression.Of the 371 included patients transplanted for ALD, 255 (68.7%) had concomitant MAFLD at LTx. Median follow-up post-LTx was 72 months (IQR: 34.50-122). Patients with ALD-MAFLD were older at LTx (p = .001), more often male (p < .001) and more frequently had hepatocellular carcinoma (p < .001). No differences in perioperative mortality and overall survival were found. ALD-MAFLD patients had an increased risk of recurrent hepatic steatosis, irrespective of alcohol relapse, but no superimposed risk of cardiovascular events.The co-presence of MAFLD at LTx for ALD is associated with a distinct patient profile and is an independent risk factor for recurrent hepatic steatosis. The use of MAFLD criteria in ALD patients might increase awareness and treatment of specific hepatic and systemic metabolic abnormalities before and after LTx.© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.