共 62 条
Optimizing patients with non-alcoholic fatty liver disease pre-transplant
被引:1
作者:
Benmassaoud, Amine
[1
]
Deschenes, Marc
[1
]
Chen, Tianyan
[1
]
Ghali, Peter
[1
,2
]
Sebastiani, Giada
[1
,3
]
机构:
[1] McGill Univ, Ctr Hlth, Dept Medicine, Div Gastroenterol & Hepatol, 1001 Blvd Decarie, Montreal, PQ H4A 3J1, Canada
[2] Univ Florida, Div Gastroenterol, Dept Med, Jacksonville, FL USA
[3] McGill Univ, Ctr Hlth, Dept Med, Chron Viral Illness Serv, Montreal, PQ, Canada
来源:
CANADIAN LIVER JOURNAL
|
2020年
/
3卷
/
03期
关键词:
cardiovascular risk;
metabolic comorbidities;
nonalcoholic fatty liver disease;
obesity treatment;
pre-transplant;
referral;
BODY-MASS INDEX;
SLEEVE GASTRECTOMY;
HEPATOCELLULAR-CARCINOMA;
CARDIOVASCULAR-DISEASE;
TRANSPLANT RECIPIENTS;
AMERICAN ASSOCIATION;
NATURAL-HISTORY;
SURVIVAL;
MORTALITY;
OUTCOMES;
D O I:
10.3138/canlivj-2019-0025
中图分类号:
R57 [消化系及腹部疾病];
学科分类号:
摘要:
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. Non-alcoholic steatohepatitis (NASH), which is the progressive counterpart of the disease, is becoming the leading indication for liver transplantation in North America. Owing to the lack of symptoms, NASH is often an incidental diagnosis, resulting in a significant proportion of patients being diagnosed when advanced liver disease has already developed. NAFLD has recently been characterized as the hepatic manifestation of metabolic syndrome. Consequently, it is a multisystem disease that often co-exists with several other conditions, such as obesity, diabetes, cardiovascular diseases, and extra-hepatic malignancy, which have an impact on selection of transplant recipients. The complexity of diagnostic approach, need for multidisciplinary clinical management, and lack of a specific treatment further complicate the picture of this extremely prevalent liver condition. NAFLD patients with advanced liver disease should be considered for early referral to liver transplant clinics for careful metabolic and cardiovascular risk stratification because they have worse survival rates after liver transplantation than other patients with chronic liver disease. Early referral will also facilitate optimization of metabolic comorbidities before proceeding with transplantation. This review provides an overview of strategies to identify patients with advanced NAFLD, with an emphasis on the management of associated comorbidities and optimal timing of pre-transplant evaluation. Other topics that have been shown to affect recipient optimization, such as the role of lifestyle changes and bariatric surgery in the management of obesity, as well as sarcopenia in decompensated NASH-related cirrhosis, are addressed.
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页码:237 / 250
页数:14
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