Liver transplantation has led to great improvements in long-term survival in patients with decompensated liver disease and hepatocellular carcinoma. Cardiovascular disease is the leading cause of non-graft-related deaths and has increased prevalence in liver allograft recipients. This is partly secondary to higher post-transplant rates of metabolic risk factors—notably obesity, hypertension, dyslipidemia, and diabetes mellitus, which comprise metabolic syndrome. Post-transplantation metabolic syndrome is expected to be a growing factor in morbidity and mortality as transplant candidates trend older, the rates of metabolic risk factors in the general population increase, non-alcoholic steatohepatitis grows disproportionally as an indication for transplantation, and post-transplantation survival lengthens.

This review discusses the incidence and contributory factors for post-transplant increases in metabolic disease, as well as the burden of cardiovascular disease in the liver allograft recipient. Patients with pre-transplant diabetes or obesity are at particularly high risk for post-transplant metabolic syndrome, and would likely benefit from closer surveillance and more aggressive medical management of risk factors. In metabolic disease resistant to initial medical therapies, tailoring of immunosuppressive regimens may further assist in minimizing long-term cardiovascular disease, although this must be done with caution to avoid worsening the risk of graft failure.

肝移植已使失代偿性肝病和肝细胞癌患者的长期存活率大大提高。心血管疾病是非移植物相关死亡的主要原因，并且在同种异体肝脏接受者中患病率上升。这部分是由于移植后代谢风险因素的发生率较高，这些因素包括构成代谢综合征的肥胖症，高血压，血脂异常和糖尿病。随着移植候选者年龄的增长，移植后代谢综合症有望成为发病率和死亡率的增长因素，普通人群中代谢危险因素的比率增加，非酒精性脂肪性肝炎作为移植的适应症成比例地增长，并且移植后生存期延长。

这篇综述讨论了移植后代谢疾病增加的发生率和成因，以及同种异体肝脏接受者心血管疾病的负担。移植前糖尿病或肥胖症患者的移植后代谢综合症风险特别高，并且可能会通过对危险因素进行更密切的监视和更积极的医学管理而受益。在对初始药物治疗有抗药性的代谢性疾病中，调整免疫抑制方案可能进一步有助于最大程度地减少长期心血管疾病，尽管必须谨慎行事，以免增加移植失败的风险。