Metabolic syndrome in liver transplantation: Relation to... : Liver Transplantation (original) (raw)

Original Articles

Metabolic syndrome in liver transplantation: Relation to etiology and immunosuppression

Bianchi, Giampaolo1,1; Marchesini, Giulio1; Marzocchi, Rebecca1; Pinna, Antonio D.1; Zoli, Marco1

1_Dipartimento di Medicina Interna and Centro Trapianti di Fegato e Multiorgano, Alma Mater Studiorum, Universitá di Bologna, Bologna, Italy_

Address reprint requests to Dipartimento di Medicina Interna, Cardioangiologia, Epatologia Università di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, I-40138 Bologna, Italy; E-mail: [email protected]

Received 25 March 2008; Accepted 9 June 2008

Published online in Wiley Online Library (wileyonlinelibrary.com).

Telephone: 39–0516364825; FAX: 39–0516363803

Abstract

Excessive weight gain, hypertension, hyperlipidemia, and diabetes are frequently observed in patients having undergone liver transplantation (LTx). These alterations are probably multifactorial in origin, and cluster to generate a metabolic syndrome (MS), increasing the risk of cardiovascular events. We assessed the prevalence of MS (National Cholesterol Education Program-Adult Treatment Panel III criteria) in 296 LTx patients in the course of regular follow-up, at least 6 months after transplantation (median, 38 months). Several pre-LTx and post-LTx data were collected to identify the factors associated with the presence of MS. In a subset of 99 patients, insulin resistance was measured by the homeostasis model assessment. High blood pressure was present in 53% of cases, hyperlipidemia in 51%, high glucose in 37%, and enlarged waist circumference in 32%. Overall, MS (defined as 3 or more of the above features) was present in 44.5% of cases. Insulin resistance (homeostasis model assessment > 2.7) was observed in 41% of cases. Hypertension and hyperlipidemia were more frequent in subjects on cyclosporine than in tacrolimus-treated cases, whereas the type of immunosuppressive drug had no effect on the prevalence of diabetes, enlarged waist, and MS. In a logistic regression analysis, only pre-LTx body mass index (odds ratio, 1.20), body mass index increase (odds ratio, 1.18), and pre-LTx diabetes (odds ratio, 2.36) predicted MS; age, gender, etiology of liver disease, time from LTx, type of immunosuppressive drug, and previous hepatocellular carcinoma were removed from the model. Disorders related to MS are frequent in LTx patients, and are related to both pre-LTx conditions and to weight gain. Weight control is mandatory in LTx patients to prevent risk factors of premature atherosclerosis. Liver Transpl 14: 1648–1654, 2008. © 2008 AASLD.