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脂肪性肝病和肝移植:候选人选择和移植后管理

Jordi Colmenero^1,2, Gonzalo Crespo^1,2, Line Carolle Ntandja Wandji³

¹Liver Unit, Hospital Clínic, Barcelona, Spain.

JHEP reports : innovation in hepatology

|February 3, 2026

概括

脂肪性肝病 (SLD) 是肝移植 (LT) 的主要原因. 管理需要多学科的护理,解决酒精使用,代谢因素和心血管风险,以改善患者和移植的生存.

科学领域:

肝病学和移植的研究
胃肠病学胃肠病学
代谢疾病代谢疾病

背景情况:

脂肪性肝病 (SLD),包括与酒精有关的肝病 (ALD) 和与代谢功能障碍相关的脂肪性肝病 (MASLD),是全球肝移植 (LT) 的主要驱动因素.
分别,ALD和MASLD是LT的主要和第二主要的指示,混合酒精和代谢病因 (MetALD) 迅速增加.
考生评价需要采用多学科的方法,考虑酒精使用,代谢综合征,肥胖,心血管疾病和癌症的复杂相互作用.

研究的目的:

审查肝移植中脂肪性肝病的当前情况.
突出患者和捐赠者评估和管理的关键考虑因素.
讨论与SLD相关的LT的成果,挑战和未来研究方向.

主要方法:

关于脂肪性肝病和肝移植的综合文献综述.
分析目前欧洲关于L.T.的适应症数据.
对SLD患者和供体移植的多学科管理策略的综合.

主要成果:

ALD和MASLD是LT的首要指示,MetALD的比例越来越大.
对酒精使用障碍 (AUD),心血管风险,虚弱和代谢并发症的综合评估对LT候选人至关重要.
接受SLD患者的5年生存率>75%,但长期结果受到心血管事件,恶性瘤和酒精复发的影响;MASLD复发很常见,但对移植存活的影响不大.
通过对捐赠者SLD的 perfusion 技术,增强了移植的利用率,挽救了约70%的边缘移植,并将早期全移植功能障碍降低了60%.

结论:

优化心脏代谢风险因素和解决酒精复发的多学科管理对于接受LT的SLD患者至关重要.
像GLP-1受体激动剂这样的新兴疗法显示出对MASLD管理的希望.
移植输液技术为利用脂肪性供体肝提供了显著的好处,改善了结果并扩大了供体库.
需要进一步的研究,以精细化风险分层,药物治疗和灌协议,以改善化移植的风险.

关键词:

这就是ALD.马什 (MASH) 是一个非常重要的产品.马斯尔德 (MASLD) 是一个在MetALD中,我们可以使用MetALD.与酒精有关的肝脏疾病.生物标志物生物标志物疾病复发疾病复发管理的管理管理的管理.与代谢相关的肝病.

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