Metabolic Syndrome Is a Risk after Liver Transplantation, Leading to Poor Outcomes

[Guest guest]

Metabolic Syndrome Is a Risk after Liver Transplantation, Leading to Poor Outcomes

SUMMARY: As people survive longer after liver transplants, the development of metabolic syndrome is a growing concern -- an epidemic waiting to happen -- according to a review article published in the December 2009 issue of Liver Transplantation. Studies indicate that diabetes, hypertension, and other manifestations of the syndrome are more common in liver transplant recipient than in similar non-transplant patients. These conditions increase the risk of cardiovascular disease, and indicate the need for better management including lifestyle modifications and lipid-lowering drugs.

By Liz Highleyman

Over years or decades, chronic hepatitis B or C infection can progress to advanced liver damage that necessitates a transplant. As post-transplant survival has improved, metabolic syndrome and its individual components -- including diabetes mellitus, hypertension, dyslipidemia (abnormal blood fat levels), and obesity -- are increasingly recognized as a contributor to cardiovascular complications and late morbidity and mortality, wrote Mangesh Pagadala and colleagues from the Digestive Disease Institute of the Cleveland Clinic Foundation.

The prevalence of post-transplant metabolic syndrome and its components has been found to be higher in transplant recipients (43%-58% after 12 to 18 months) compared with an otherwise comparable population who do not receive transplants (about 25%). The development of nonalcoholic fatty liver disease (NAFLD) after liver transplantation (for reasons other than non-NAFLD cirrhosis) is also increasingly recognized. Most patients with liver disease severe enough to require a transplant have some degree of insulin resistance, and this typically improves after transplantation. Persistent or newly emerging insulin resistance post-transplantation, however, is a cause for concern.Several potential pre-transplant risk factors for post-transplant metabolic syndrome have been identified, including older age, male sex, history of smoking, higher pre-transplant body mass index (of the

liver recipient or donor), and pre-transplant diabetes. Patients who receive transplants due to hepatitis C, alcoholic cirrhosis, or cryptogenic (unknown cause) cirrhosis are also at higher risk. Another risk factor is immunosuppression, caused by drugs used to prevent organ rejection (also suggesting potential concern for people with HIV).Patients with post-transplant metabolic syndrome have an increased risk of cardiovascular events, organ rejection, and all types of infection, the researchers noted. According to one study, the risk of cardiovascular events was about 30% among people who developed post-transplant metabolic syndrome, compared with 8% among people who did not. However, the overall impact of metabolic syndrome on long-term survival and mortality remains to be determined.Strategies to reduce the development of metabolic syndrome -- both before and after transplantation -- should include lifestyle modifications

involving improved diet, increased physical activity, and weight loss, they concluded. Additional measures that may be beneficial include use of lipid-lowering medications, optimal blood glucose control, and use of tacrolimus instead of cyclosporine for immune suppression.Department of Gastroenterology & Hepatology and Department of Hepatobiliary Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH.1/15/10

ReferenceM Pagadala, S Dasarathy, B Eghtesad, and AJ McCullough. Posttransplant metabolic syndrome: an epidemic waiting to happen. Liver Transplantation 15(12): 1662-1670 (Abstract). December 2009.

http://www.hivandhepatitis.com/hep_c/news/2010/011510_b.html