Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

Abstract

Key Points 1. As long-term survival improves after liver transplantation, cardiovascular complications are emerging as a major cause of late morbidity and mortality. It seems reasonable to correct the potentially reversible cardiovascular risk factors of diabetes, hyperlipidemia, and obesity, in addition to hypertension. 2. The results of liver transplantation in diabetics are acceptable in terms of morbidity, mortality, and prevalence of posttransplant diabetes, but the poor outcomes described in some series suggest that more extensive testing for macro-and microvascular disease may become necessary. T he main aim of liver transplantation, besides the immediate goal of saving life, is to return the patient to productive community living with good quality of life. It is ironic, therefore, that many of the health problems that afflict successful liver transplant recipients long term are those of community living in the developed world, including diabetes mellitus, hyperlipidemia, and obesity. These three metabolic derangements, together with hypertension, constitute adverse cardiovascular risk factors for transplant recipients. The management of diabetes in liver transplant recipients is not substantially different from its management in

Rapamycin Protects Against High Fat Diet–Induced Obesity in C57BL/6J Mice

“…In addition, our in vivo studies showed that inhibiting the mTOR pathway leads to a decrease in obesity. These novel observations however conflict with that of prolonged use of rapamycin in humans which is associated with excessive weight gain, severe hyperinsulinemia, insulin resistance, and hyperglycemia in organ transplant patients (45,50,51). Taken together, these observations indicate that a considerable adverse effect of RAPA may exist for patients in a cachexia condition.…”

“…These endogenous molecules' association with food intake may work within the mTOR pathway or interact with each other in the hypothalamus (45). However, further investigation is necessary to determine the details of how these factors interact.…”

Prevalence of Metabolic Syndrome in Organ Transplantation: A Review of the Literature

“…Weight gain after liver transplantation has been widely reported, with about two-thirds of patients becoming obese soon after transplant [17]. There is much debate as to the cause of this weight gain, but several factors, including immunosuppressive drugs and a return of normal diet and appetite have been suggested.…”

Excesso de peso em pacientes submetidos ao transplante hepático

“…In addition, patients undergoing liver transplantation feel freed from pre-transplant restrictions dietary and no longer have anorexia. They also have a higher sense of well-being and anxiety to regain the weight lost while waiting for transplantation 15 . Still, it is likely that patients return to old eating habits; the contribution of a history of overweight has been widely described as a risk factor for excessive weight gain and obesity 8 Table 1 Table 1 Table 1 Table 1 Table 1 Incidence and prevalence of excess weight, overweight and obesity after liver transplantation.…”

“…Also, they feel better and are able to feed in appreciable quantities. At the same time, they feel eager to regain the weight lost during the months of waiting for transplantation 14,15 , since 75% of them are malnourished during this period 16 . Moreover, many patients do not return to work after surgery 17 and those surviving for long periods have levels of daily physical activity significantly lower than the general population 4.…”