Disturbed energy metabolism after lung and heart transplantation

Abstract

Overweight, in combination with other cardiovascular risk factors, reduces survival after transplantation. The aim of this prospective study was to observe leptin, adiponectin, and energy intake as predictors of body mass index (BMI) and body composition and as risk factors associated with metabolic syndrome after lung and heart transplantation. After pre-operative baseline investigations, 35 lung and 59 heart recipients were followed and re-investigated two, six, and 12 months after transplantation. Linear regressions were performed to predict BMI and body composition. The lung recipients had a substantial weight gain after transplantation. Leptin increased, especially in the lung recipients and positively predicted BMI. Energy intake predicted BMI before and at two months after transplantation, but not after 12 months. Percentage trunk fat increased and lean mass decreased. Before transplantation, the dominant determinant of lean mass was adiponectin (positively associated), while after it was leptin (negatively associated), controlled for possible confounding variables (including prednisolone). Metabolic syndrome 12 months after transplantation was associated with higher leptin, greater weight gain without increased energy intake. After transplantation, a disturbed energy metabolism is indicated, where adiponectin and especially leptin are involved and a disadvantageous body composition is favored with increased body fat and decreased lean mass.

Evolution of body weight parameters up to 3 years after solid organ transplantation: The prospective Swiss Transplant Cohort Study

“…Liver Tx recipients showed a different pattern of weight loss, which might be explained by the loss of ascites and edema following Tx. Our results confirm previous findings of post‐Tx weight gain, especially in the first year after Tx . However, with regard to the timeframe used in our analysis (from 6 months to 1 year), the mean weight gain in the Swiss Tx populations is still slightly lower than that of international studies in liver (means of 3 and 4 kg), lung (mean 3.4 kg), and heart Tx patients (mean 2.3 kg) .…”

“…Our results confirm previous findings of post‐Tx weight gain, especially in the first year after Tx . However, with regard to the timeframe used in our analysis (from 6 months to 1 year), the mean weight gain in the Swiss Tx populations is still slightly lower than that of international studies in liver (means of 3 and 4 kg), lung (mean 3.4 kg), and heart Tx patients (mean 2.3 kg) . Studies in kidney Tx examined post‐Tx weight gain only from time of Tx to 1 year post‐Tx (means ranging from 2.3 to 10.3 kg) .…”

“…In the United States, for example, approximately 30% of kidney and liver Tx patients are obese at the time of Tx, while the numbers in heart and lung Tx are 22.7% and 15.2%, respectively. Also mean weight gain in the first year after Tx varies across organ groups, for example, 1.1 kg in heart vs 9.2 kg in liver Tx, and across geographic regions, for example, 2.7 kg weight gain in kidney Tx recipients in France vs 10.3 kg in the United States …”

“…Importantly, few studies addressing weight parameters in solid organ Tx have examined weight changes longer than 1‐year post‐Tx. Additionally, except for a small number of notable exceptions, the vast majority of studies focus on individual centers and on a solitary Tx population only.…”

Rehabilitation in Patients before and after Lung Transplantation

“…Increased participation in physical activity and associated health effects could either be achieved by supervised exercise training interventions in the early posttransplant period or by lifestyle physical activity programs, such as pedometer-based walking interventions, in the later posttransplant period. Weight gain after transplantation is a common problem, and metabolic/cardiovascular morbidities such as hypertension, diabetes, and hyperlipidemia, which might be modifiable by physical activity and exercise, rank among the five most common morbidities after lung transplantation [2,33]. …”