Association between obesity after liver transplantation and steatosis, inflammation, and fibrosis of the graft

Abstract

During the last decades, advanced surgical techniques and immunosuppressive therapy have led to excellent survival after liver transplantation. The survival rates reach up to 83% after 1 year, 61% after 10 years, and 41% after 20 years. 1 However, there is an increase in medical complications unrelated to the graft, such as de novo malignancies, recurrence of the underlying disease, metabolic complications, and cardiovascular diseases. 2-7 Cardiovascular factors cause 19%-42% of all deaths after liver transplantation. The individual cardiovascular risk profile is thought to be affected by metabolic syndrome, which is at least partially associated with immunosuppressive therapy. 2,4,7,8 Metabolic syndrome is defined by obesity, dyslipidemia, arterial hypertension, and hyperglycemia, and is one of the most frequent post-transplant complications. Its prevalence after transplantation ranges from 44% to 58% according to

Hepatic steatosis after liver transplantation: a systematic review and meta-analysis

“…Fifteen studies provided specific cutoffs of alcohol consumption for exclusion of patients for analysis, namely 3 studies considered any alcohol use,19–21 2 studies more than 30–40 g/wk,22,23 2 studies 10 g/d,24,25 3 studies 20 g/d,26–28 and 5 studies 20–30 g/d in women, and 30–40 g/d in men 29–33. Finally, 12 studies did not take into account alcohol intake 34–45…”

“…[29][30][31][32][33] Finally, 12 studies did not take into account alcohol intake. [34][35][36][37][38][39][40][41][42][43][44][45] Most studies did not specify the diagnostic criteria for the metabolic comorbidities; however, the ones who specified it used similar criteria. Regarding obesity, non-Asian studies considered a BMI at least 30 kg/m 2 , [6,7,19,20,22,26,27,29,30,[34][35][36] whereas Asian studies used either 25 [8,9] or 27.5 kg/m 2 , [10] according to guidelines for Asian subjects.…”

“…[34][35][36][37][38][39][40][41][42][43][44][45] Most studies did not specify the diagnostic criteria for the metabolic comorbidities; however, the ones who specified it used similar criteria. Regarding obesity, non-Asian studies considered a BMI at least 30 kg/m 2 , [6,7,19,20,22,26,27,29,30,[34][35][36] whereas Asian studies used either 25 [8,9] or 27.5 kg/m 2 , [10] according to guidelines for Asian subjects. Definitions of diabetes mellitus (DM) was similar among studies that reported it, [7][8][9][10]20,26,27,29,30,34,35] with occasional glucose levels at least 200 mg/dL, fasting glucose at least 126 mg/dL, or hemoglobin HA1c at least 6.5%, according to accepted guidelines.…”

“…Importantly, 8 studies (comprising 1290 patients) evaluated only de novo NAFLD and 8 (comprising 1059 patients) only recurrent NAFLD. Baseline hepatocellular carcinoma was not an exclusion criterion in 13 studies [7][8][9]13,20,23,30,[32][33][34][35][36]43] and 4 studies included patients transplanted for acute liver failure. [22,23,30,40] Study characteristics and main findings are presented in Table 1.…”

“…The development of post-LT steatohepatitis was described in 23 studies, [6,8,[12][13][14]16,17,19,21,22,24,25,28,29,31,[33][34][35][36]39,[45][46][47][48] with highly variable results. In a pooled analysis, steatohepatitis occurred in 28.82% (19.62, 38.03) of patients who developed post-LT steatosis 7).…”