De novo nealkoholová tuková choroba pečene po transplantácii pečene – diagnostikovaná pomocou magnetickej rezonancie

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Autoři: Skladaný Ľ. ¹; Adamcova-Selcanova S. ¹; Ciefova J. ¹; Bystrianska N. ¹; Skvarkova B. ¹; Bachova B. ¹; Koller T. ²
Působiště autorů: HEGITO – Hepatology, Gastroenterology and Liver Transplantation Division of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Hospital, Banska Bystrica, Slovakia ¹; 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava Ruzinov, Bratislava, Slovakia ²
Vyšlo v časopise: Gastroent Hepatol 2020; 74(2): 116-122
Kategorie: Hepatologie: původní práce
doi: https://doi.org/10.14735/amgh2020116

Souhrn

Východiská: Nealkoholová tuková choroba pečene (NAFLD) je jednou z najčastejších príčin chronického ochorenia pečene a zároveň indikácií transplantácie pečene (LTx). NAFLD, ktorá vznikne po LTx pre inú indikáciu sa nazýva de novo NAFLD.

Cieľ: Určiť výskyt de novo NAFLD za pomoci diagnostiky magnetickej rezonančnej (MR) spektroskopie (MRS).

Metódy: Prospektívna analýza údajov za sebou idúcich pacientov po LTx v intervale medzi januárom 2015 a decembrom 2019. Do štúdie boli zaradení pacienti transplantovaní pre cirhózu pečene na podklade inej etiológie ako NAFLD. Vylúčení boli pacienti po LTx pre NAFLD, so závažnými komplikáciami < 2 mesiace po LTx a tý, ktorí zomreli < 3 mesiace po LTx. Sledovali sme demografické a antropometrické charakteristiky, laboratórne parametre potrebné na výpočet indexu tuku v pečeni (FLI – fatty liver index) a MRS v mesiacoch 3, 6, 12, 24 po LTx. NAFLD bola diagnostikovaná pri FLI ≥ 60 a pri MRS obsah tuku v pečeni ≥ 5%

Výsledky: V sledovanom intervale bolo vykonaných 164 LTx u 153 pacientov, vylúčili sme 6 pacientov (4 %) po LTx pre NAFLD a 52 pacientov (34 %) podľa vopred stanovených kritérií. Do definitívnej analýzy sme zaradili 95 pacientov (62 %), s vekom 50,4 rokov (18–70), 38 % žien, s MELD (model for end stage liver disease) 15,7 bodov, s Child-Pugh skóre 8,9 bodov.

Etiológia: Alkoholová choroba pečene 44 pacientov ( 46 %), primárna sklerotizujúca cholangitída 16 (17 %), autoimunitné ochorenia 12 (13 %), rôzne 8 (9 %), hepatocelulárny karcinóm 7 (7 %), vírusové hepatitídy 3 (3 %), sekundárna biliárna cholangitída 3 (3 %), Wilsonova choroba 2 (2 %). Body mass index (BMI) kg/ m², v čase LTx, mesiace 3, 6, 12: 25,76; 24,6; 24,95; 26,5 (p < 0,01); FLI (mesiace 3, 6, 12, 24): 48,663 ± 5,878; 51,628 ± 6,166; 50,901 ± 7,075; 55,211 ± 13,832; MRS (> 5 % tuku, mesiace 6, 12, 24): 26,5; 32,1; 42,9 (p = 0,368); MRS (% tuku, medián, mesiace 6, 12, 24): 3,45; 4 (p = 0,045); 5 (p = 0,08). MR elastografia (≥ 2,88 kPa, mesiace 6, 12, 24): 26,8; 29,6 (p = 0,07); 46,2 (p = 0,1).

Záver: V sledovanej kohorte sme identifikovali so stúpajúcim trendom BMI zároveň vzostup obsahu Etiology po LTx. Šesť mesiacov po LTx sme pomocou MRS detegovali viac ako 5 % tuku v pečeni u 1/4 pacientov. V čase 6 a 12 mesiacov po LTx bola fibróza prítomná u 26 a 29 % pacientov. Klinický význam zatiaľ nepoznáme.

Klíčová slova:

transplantácia pečene – FLI – MR spektroskopia – MR elastografia – de novo NAFLD

Zdroje

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