肥胖在肝移植临床实践中的挑战与管理策略

Challenges and management strategies of obesity in the clinical practive of liver transplantation

摘要

肥胖已成为影响肝移植全程管理的重要因素之一，其作用不仅体现在供者肝脂肪变、缺血-再灌注损伤风险增加，也涉及受者围手术期技术难度增加、术后代谢并发症增多及长期预后差。本文结合近年来相关研究，从肥胖供者利用、成人及儿童受者特点、移植前风险评估与减重干预、移植后体重及代谢管理等方面进行综述。现有证据提示，单纯以体重指数判断移植风险存在局限，身体成分分析、心血管功能评估及肌少性肥胖识别更具临床价值。对肥胖肝移植受者，应在多学科协作基础上，重视个体化筛选、围手术期优化及长期随访管理，以改善移植物和受者结局。

Abstract

Obesity has become one of the important factors affecting the entire management process of liver transplantation. Its impact is not only reflected in the increased risk of liver steatosis and ischemia-reperfusion injury in the donor, but also involves the increased technical difficulty during the perioperative period for the recipient, the increase in postoperative metabolic complications and poorer long-term prognosis. This article, based on recent relevant studies, reviews aspects such as the utilization of obese donors, the characteristics of adult and pediatric recipients, pre-transplant risk assessment and weight loss intervention, and post-transplant weight and metabolic management. Current evidence suggests that simply judging transplantation risks based on body mass index has limitations. Analysis of body composition, assessment of cardiovascular function and identification of sarcopenic obesity are more clinically valuable. For obese liver transplant recipients, in a multidisciplinary collaboration framework, emphasis should be placed on individualized screening, perioperative optimization and long-term follow-up management to improve the outcomes of the graft and the recipient.

关键词

肥胖 / 肝移植 / 代谢功能障碍相关脂肪性肝病 / 移植预后 / 体重指数 / 肝脂肪变 / 肌少性肥胖 / 心血管风险

Key words

Obesity / Liver transplantation / Metabolic dysfunction-associated steatotic liver disease / Transplant prognosis / Body mass index / Hepatic steatosis / Sarcopenic obesity / Cardiovascular risk

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基金资助

云南省教育厅科学研究基金项目(2024J0296)

云南省“十四五”期间国家级临床重点专科建设项目(云卫办医发（2023）10号)