Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation

Abstract

Summary The metabolic syndrome (MetS) might contribute to morbidity after orthotopic liver transplantation (OLT). For this reason, we searched for MetS‐associated risk factors and analyzed the link with nonalcoholic fatty liver disease (NAFLD) in OLT recipients. De novo MetS affected 32.9% of our cohort (n = 170) within 2 years after OLT. Multivariate analysis identified glycosylated hemoglobin (HbA1c) levels ≥5% [odds ratio (OR) = 3.5; 95% confidence interval (CI) = 1.56–8.13, P = 0.003], diabetes mellitus (OR = 4.31, CI = 1.69–10.99, P = 0.002), and arterial hypertension (OR = 4.59, CI = 1.46–14.49, P = 0.009) as independent risk factors for de novo MetS. MetS incidence correlated with steroid dosage after OLT (5.2 ± 2.4 mg/day vs. 7.1 ± 4.7 mg/day, P = 0.014), and was linked to NAFLD (P = 0.001) via obesity (OR = 4.67, CI = 1.55–14.1, P = 0.006) and dyslipidemia (OR = 4.23, CI = 1.35–13.3, P = 0.013) post‐OLT. In conclusion, we were able to identify low threshold HbA1c as a novel risk factor for MetS after OLT and described a link of MetS with NAFLD in transplant organs. This study also indicated that steroid treatment is associated with MetS rates after OLT.

Histologically proven non‐alcoholic fatty liver disease and clinically related factors in recipients after liver transplantation

“…Other factors previously considered significant for NAFLD in other studies such as dyslipidemia, DM, hypertension, metabolic syndrome, long‐term steroid use, and tacrolimus‐based immunosuppressant were found not to be related to post‐LT NAFLD in the present study . From these findings, there is a possibility that post‐LT NAFLD might be a distinct entity from general NAFLD, which is not related to LT.…”

“…Obesity at the time of biopsy was another significant factor for post‐LT NAFLD (OR 3.873, p = 0.001). This finding is perhaps not surprising, considering NAFLD is strongly associated with obesity in both liver transplant and general population .…”

Non-alcoholic fatty liver disease: An expanded review

“…Additionally, the rate of metabolic syndrome development post liver transplant is approximately 50%-60%[85]. In a cohort comprising 170 transplant patients followed for two years, the researchers showed the presence of metabolic syndrome in approximately one-third[86]. Not surprisingly, the incidence of NAFLD after having received a liver transplantation ranges from 18%-40% and the incidence of NASH ranges from 9%-13%[87].…”

Prospective evaluation of metabolic syndrome and its components among long‐term liver recipients

“…The study of MS after LTx is still new. Although the disorder can affect up to half of these patients and is a risk factor for fatty liver disease , cardiovascular disease and fibrosis , most studies have not focused on MS in patients many years after LTx . As the shorter duration of follow‐up after transplantation may be related to the higher prevalence of MS , studies of longer term liver recipients are required to better describe this condition after LTx.…”