No abstract

There is a high prevalence of metabolic syndrome in liver transplant recipients, a population that tends to be physically inactive. The aim of this study was to characterize physical activity and evaluate the relationship between physical activity and metabolic syndrome after liver transplantation. A cross-sectional analysis was performed in patients more than 3 months after transplantation. Metabolic syndrome was classified according to National Cholesterol Education Panel Adult Treatment Panel III guidelines. Physical activity, including duration, frequency, and metabolic equivalents of task (METs), was assessed. The study population consisted of 204 subjects, with 156 more than 1 year after transplantation. The median time after transplantation was 53.5 months (range 5 3-299 months). The mean duration of exercise was 90 6 142 minutes, and the mean MET score was 3.6 6 1.5. Metabolic syndrome was observed in 58.8% of all subjects and in 63.5% of the subjects more than 1 year after transplantation. In a multivariate analysis involving all subjects, metabolic syndrome was associated with a time after transplantation greater than 1 year [odds ratio (OR) 5 2.909, 95% confidence interval (CI) 5 1.389-6.092] and older age (OR 5 1.036, 95% CI 5 1.001-1.072). A second analysis was performed for only patients more than 1 year after transplantation. In a multivariate analysis, metabolic syndrome was associated with lower exercise intensity (OR 5 0.690, 95% CI 5 0.536-0.887), older age (OR 5 1.056, 95% CI 5 1.014-1.101), and pretransplant diabetes (OR 5 4.246, 95% CI 5 1.300-13.864). In conclusion, metabolic syndrome is common after liver transplantation, and the rate is significantly higher in patients more than 1 year after transplantation. The observation that exercise intensity is inversely related to metabolic syndrome after transplantation is novel and suggests that physical activity might provide a means for reducing metabolic syndrome complications in liver transplant recipients. Liver Transpl 19:1125-1131, 2013. V C 2013 AASLD.Received April 17, 2013; accepted June 30, 2013.Liver transplantation provides lifesaving therapy for patients with acute or chronic liver failure and hepatocellular carcinoma. However, liver transplant recipients face long-term complications, including metabolic abnormalities and an increased risk of cardiovascular disease.1-4 Metabolic syndrome affects 45% to 58% of liver transplant patients, and the prevalence is particularly high in patients with metabolic syndrome in the pretransplant period.

Women with NASH cirrhosis had a higher risk of death on the LT waiting list and were less likely to receive LT compared to men.

Cirrhotic complications portend high morbidity and mortality and burden the health care system. Established quality measures in management of cirrhotics include screening for esophageal varices (EV), screening for hepatocellular carcinoma (HCC), and hepatitis A and B immunization. A retrospective review was conducted to identify adherence to cirrhosis. Baseline rates were shared with providers. Compliance with quality measures was measured prospectively at 1-month, 2-month, 1-year, and 3-year follow-up after provision of performance feedback. Baseline HCC rate was 60%, EV was 68%, and hepatitis A and B immunization was 51% and 47%, respectively. After performance feedback, HCC, EV, and hepatitis A and B vaccination rates improved to rates ranging from 92% to 100% and remained statistically significant after 3 years. Provider feedback, a simple intervention, achieved significant improvement in compliance with quality measures for management of cirrhotics. This improvement in adherence to quality measures was sustainable over a 3-year time period.