Dereglările metabolice la pacienții cu transplant hepatic
DOI:
https://doi.org/10.52556/2587-3873.2025.2(104).30Cuvinte cheie:
transplant hepatic, obezitate, dislipidemie, hipertensiune arterială, sindrom metabolicRezumat
Supraviețuirea globală în perioada post-transplant hepatic (TH) s-a îmbunătățit semnificativ în ultimele decenii ca urmare a selectării mai eficiente a regimurilor de imunosupresie, a tehnicilor operative îmbunătățite și a managementului perioperator. Morbiditatea și mortalitatea pe termen lung post- TH au rămas semnificative, atribuite incidenței crescute a complicațiilor metabolice și celor maligne. Scopul: sintetizarea datelor din literatura de specialitate referitoare la dereglările metabolice dezvoltate la pacienții cu transplant hepatic. A fost realizată o revizuire narativă a literaturii, utilizând baze de date precum PubMed, Scopus și Web of Science, relevante pentru dereglările metabolice la pacienții cu TH. Tulburările metabolice la primitorii de TH pot fi moștenite din condițiile pre-transplant sau se pot dezvolta ca o consecință sau exacerbare a regimurilor imunosupresoare convenționale (corticosteroizi, inhibitori ai calcineurinei și inhibitori m-TOR), agravate de un stil de viață inadecvat. Este necesară o abordare multidisciplinară a acestor pacienți, cu adaptarea unui mod sănătos de viață, printr-o reducere a riscului de creștere a masei grăsoase, printr-o dietă echilibrată și aport lipidic și proteic limitat. Tulburările metabolice la pacienții supuși TH reprezintă principala provocare datorită impactului asupra rezultatului pe termen lung. Respectarea și monitorizarea unei diete hipocalorice, programele de exerciții fizice structurate trebuie recomandate și implementate pentru toți primitorii de TH atât în prevenirea, cât și în tratamentul tulburărilor metabolice. O abordare personalizată în utilizarea medicamentelor imunosupresoare este un punct principal pentru evitarea riscului de rejet și riscului metabolic.
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