De novo tuková choroba pečene po transplantácii pečene a fibróza pečene diagnostikovaná magnetickou rezonanciou počas dvoch rokov

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Autoři: S. Adamcová Selčanová ¹ ; L. Skladaný ¹ ; Škvarková B. ¹; Bachova B. ¹; L. Lafférs ² ; T. Koller ³
Působiště autorů: HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation), FD Roosevelt Hospital, Banska Bystrica, Slovakia ¹; Department of Mathematics, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia ²; Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava Ruzinov, Bratislava, Slovakia (Slovakia) ³
Vyšlo v časopise: Gastroent Hepatol 2022; 76(2): 112-120
Kategorie: Původní práce
doi: https://doi.org/10.48095/ccgh2022112

Souhrn

Úvod: Nealkoholová tuková choroba pečene (NAFLD) je najrýchlejšie rastúcou príčinou ochorení pečene. Pri vzniku po transplantácii pečene (LT) pre iné indikácie nesie názov de novo NAFLD. Cieľ: Stanoviť incidenciu de novo NAFLD a jej asociáciu s BMI a fibrózou po LT v jednom transplantačnom centre. Metódy: Medzi januárom 2015 a decembrom 2020 sme realizovali propektívnu observačnú štúdiu u po sebe nasledujúcich pacientov po LT pre iné indikácie ako NAFLD. Sledovali sme demografické ukazovatele, etiológiu cirhózy pečene, MELD sklóre a Child Pugh skóre. Šesť, 12 a 24 mesiacov po LT sme hodnotili BMI, MR spektroskopiu (MRS, [≥ 5 % = NAFLD]) a MR elastografiu (MRE, [≥ 2,88 kPa = signifikantná fibróza, ≥ 3,54 kPa = pokročilá fibróza]). Výsledky: V sledovanom intervale sme do štúdie zaradili 164 pacientov po LT. Na základe vopred definovaných kritérií sme vylúčili 37 pacientov, do finálnej analýzy sme zaradili 104 pacientov s mediánom 53 rokov, 38 % žien, s mediánom MELD 15 bodov a BMI 25,4. Medián BMI – 6, 12 a 24 mes. po LT bol 25,5 vs. 27,3 (p = 0,032) a 26 vs. 27,8 (p = 0,062). MRS % – 6, 12 a 24 mes. po LT boli 4,5 oproti 5,1 (p = 0,2) a 4,4 oproti 7 (p = 0,012). Šesť, 12 a 24 mesiacov po LT sme signifikantnú fibrózu zistili u 27 %, 35 % a 46 % (p = 0,09) a pokročilú fibrózu u 4,7 %, 1,2 % a 15 % pacientov (p = 0,003). Závery: Počas dvoch rokov po LT pre iné indikácie ako NAFLD sme zaznamenali stúpajúci trend BMI, stúpajúci výskyt de novo NAFLD, signifikantnej a pokročilej fibrózy.

Klíčová slova:

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

Zdroje

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