Prevalence and Risk Factors of Metabolic Syndrome After Liver Transplantation: A Single Centre Experience

Pepe, Vito; Germani, Giacomo; Ferrarese, Alberto; Zanetto, Alberto; Bortoluzzi, I.; Nadal, E.; Russo, Federico; Senzolo, Marco; Gringeri, Enrico; Cillo, U.; Burra, P.

doi:10.1016/j.dld.2015.01.113

Cited by 3 publications

(4 citation statements)

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“…Moreover, no histological data regarding the development of NASH after LT were available, since protocol liver biopsies were not routinely performed and were reserved only for patients with alterations of liver function tests to exclude other potential complications (i.e., acute cellular rejection) 35 . Although the incidence of CV events were not outcomes of the present study, we confirmed the results of a preliminary experience from a retrospective cohort (n = 161) from our center, in which less than 5% of patients developed a major CV event with a median follow‐up of 7 years after LT 36 …”

Section: Discussionsupporting

confidence: 82%

A prospective longitudinal assessment of de novo metabolic syndrome after liver transplantation

Becchetti

Ferrarese

Zeni

et al. 2021

Clinical Transplantation

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Background De novo metabolic syndrome (MS) is a frequent complication after liver transplantation (LT). The aim of this prospective study is to identify potential risk factors longitudinally associated to post‐LT de novo MS. Patients without pre‐LT MS who underwent LT between April 2013 and October 2017 were prospectively included. Metabolic variables were collected at LT and at 6, 12, and 24 months post‐LT. Results Sixty‐three patients fulfilled the inclusion criteria (76% male, mean age 53.6±9.5 years). The prevalence of de novo MS was 46%, 43%, and 49% at 6, 12, and 24 months after LT, respectively. Among other MS components, the prevalence of type 2 diabetes, hypertension and hypertriglyceridemia significantly increased after LT. Considering the baseline characteristics at the adjusted analysis, alcoholic liver disease (OR 4.17, 95%CI 1.20‐14.51; p = .03) and hypertension pre‐LT (OR 11.3, 95% CI 1.49‐85.46; p = .02) were confirmed as independent risk factors of post‐LT de novo MS. In the time‐varying analysis, only eGFR (OR .97, 95% CI .97‐.98; p < .0001) was found associated with post‐LT de novo MS. Conclusions De novo MS frequently occurs shortly after LT, affecting nearly half of patients at 24 months post‐LT. Lifestyle modifications should be recommended starting early post‐LT, particularly for patients with established risk factors.

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Section: Discussionsupporting

confidence: 82%

A prospective longitudinal assessment of de novo metabolic syndrome after liver transplantation

Becchetti

Ferrarese

Zeni

et al. 2021

Clinical Transplantation

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“…Prevalence of Post‐Transplant Metabolic Syndrome (PTMS) defined according to International Criteria, ranged from 44% to 58% and is expected to rise in the next years . Identified risk factors for PTMS are male gender, higher pre‐LT BMI and pre‐LT diabetes …”

Section: Emerging Indications For Liver Transplantationmentioning

confidence: 63%

“…100 Identified risk factors for PTMS are male gender, higher pre-LT BMI and pre-LT diabetes. 111 Despite NODAT, hypertension, dyslipidemia and other met- There are several reports indicating that a modest expansion of the MC could increase the number of selected candidates to LT without negative impact on survival. 113 A potential extension of the criteria for LT in HCC must take into account the benefit for individual with HCC as well as the consequences for all potential liver recipients.…”

Section: Non-alcoholic Fatty Liver Diseasementioning

confidence: 99%

Current challenges and future directions for liver transplantation

Toniutto

Zanetto

Ferrarese

et al. 2016

Liver International

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Liver transplantation is an effective and widely used therapy for several patients with acute and chronic liver diseases. The discrepancy between the number of patients on the waiting list and available donors remains the key issue and is responsible for the high rate of waiting list mortality. The recent news is that the majority of patients with hepatitis C virus related liver disease will be cured by new antivirals therefore we should expect soon a reduction in the need of liver transplantation for these recipi-

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“…7 Preexisting metabolic syndrome can worsen, or patients may develop de novo metabolic syndrome after LT with incidence of de novo metabolic syndrome reported to be 33%, 27%, and 40% at 3, 6, and 12 months after LT, respectively. 8 Management of posttransplant obesity and metabolic syndrome frequently involves lifestyle interventions including structured exercise programs and dietary modifications. Weight loss on these programs should have similar benefits as compared with the nontransplant population, that is, reversal of steatosis, inflammation, and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Successful Outcome of Bariatric Surgery in Living Donor Liver Transplant Recipients With Multidisciplinary Approach: A Preliminary Experience

Singhal

Dhampalwar

Saigal

et al. 2021

Journal of Clinical and Experimental Hepatology

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Introduction: Liver transplant recipients may develop weight gain, metabolic syndrome, and subsequent nonalcoholic steatohepatitis of the transplanted liver which impairs graft function. Bariatric surgery is an effective modality for management of morbid obesity and metabolic syndrome. Our aim is to review the role of bariatric surgery in such high-risk posttransplant patients not responding to medical management and highlight the important considerations. Methodology: We review the management of two cases with posttransplant metabolic syndrome not responding to medical management and discuss the literature available on bariatric surgery in organ transplant patients. Results: The first patient was a 51-year-old man who underwent living donor liver transplantation 3 years prior, and follow-up ultrasound and fibroscan was suggestive of steatohepatitis of the graft. After liver transplantation, he had gained 30 Kg weight and was on oral hypoglycemic agents with HbA1c of 8%. The second patient was a 65-year-old man, who gained 30 Kg weight with risk of graft impairment 4 years after of combined liver and kidney transplant. Both patients were evaluated thoroughly preoperatively for risk stratification including an upper gastro-intestinal (GI) endoscopy. The immunosuppression was reduced and monitored closely perioperatively. Both patients underwent laparoscopic sleeve gastrectomy (LSG) and were discharged on postoperative day 3. The first patient was evaluated a year after surgery with body mass index (BMI) reduction from 42 to 34 and second at 2 months with BMI reduction from 38 to 33; both patients were free of diabetes and had stable graft functions. Conclusion: Bariatric surgery in liver transplant recipients has significant challenges with higher complication rates as patients are on immunosuppression which often impairs wound healing. LSG is safe and effective in such patients which often requires good coordination between the bariatric team and liver transplant team.

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Prevalence and Risk Factors of Metabolic Syndrome After Liver Transplantation: A Single Centre Experience

Cited by 3 publications

References 0 publications

A prospective longitudinal assessment of de novo metabolic syndrome after liver transplantation

A prospective longitudinal assessment of de novo metabolic syndrome after liver transplantation

Current challenges and future directions for liver transplantation

Successful Outcome of Bariatric Surgery in Living Donor Liver Transplant Recipients With Multidisciplinary Approach: A Preliminary Experience

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