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Post-liver transplant metabolic syndrome linked to obesity, diabetes

Factors such as obesity and current and family history of diabetes increased the likelihood of developing metabolic syndrome following liver transplantation in a recent study.

Researchers evaluated 84 patients (mean age, 53.9 years; 75% men) with cirrhosis before and after undergoing orthotopic liver transplantation (OLT). BMI, waist circumference, blood pressure and nutritional intake were assessed before and 3, 6 and 12 months after transplantation, along with biochemical factors including glucose, triglycerides, cholesterol and ALT.

Metabolic syndrome was observed in 16.6% of patients 3 months before transplantation, and in 32.1% at 3 months, 35.7% at 6 months and 39.5% 12 months after transplantation. Post-transplant metabolic syndrome (PTMS) was attributed to an increase in patients with arterial hypertension and hypertriglyceridemia, while prevalence of diabetes, obesity, low HDL and impaired fasting glucose did not change significantly post-transplant.

Patients with PTMS had diabetes, obesity, dyslipidemia, hypertension and a family history of diabetes significantly more frequently and were significantly older, with higher BMI and greater fat mass and waist circumference, than those without the condition. Multivariate analysis indicated significant associations between PTMS and diabetes (P=.013), family history for diabetes (P=.005) and elevated BMI (P=.001).

Patients who developed PTMS had a larger increase of total energy and saturated fat intake after transplantation compared with those without PTMS, while fiber intake was lower at 12 months post-transplant (P=.01 for all comparisons). Cardiovascular disease (CVD) events were more common among PTMS patients (16.3% vs. 0%; P=.01), while differences were observed in incidence of acute graft rejection (40.8% vs. 28.6%; P=.178) and infection (38.8% vs. 22.9%; P=.095).

“These data show that the development of PTMS is an early phenomenon and is related to pre-OLT diabetes and obesity and to nutritional changes after OLT,” the researchers wrote. “Lifestyle modifications, especially in overweight and/or obese patients, should be recommended to transplanted individuals starting in the early post-OLT period. This would facilitate prevention of body weight gain and the assorted abnormalities, including dyslipidemia and hypertension, thus reducing the incidence of PTMS and the related CVD complications.”