Medical management of metabolic and cardiovascular complications after liver transplantation

Becchetti, Chiara; Dirchwolf, Melisa; Banz, Vanessa; Dufour, Jean‐François

doi:10.3748/wjg.v26.i18.2138

Cited by 32 publications

(34 citation statements)

References 125 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, new findings have highlighted how obesity [58], diabetes type II [59], and arterial hypertension [60] are associated with a more severe course of COVID-19 and hence a poorer outcome. Despite the high prevalence of these metabolic conditions in LT recipients [61,62] and more specifically in the present cohort, this did not seem to negatively affect the prognosis of the current study population.…”

Section: Discussioncontrasting

confidence: 54%

COVID-19 in Liver Transplant Recipients: A Systematic Review

Becchetti

Gschwend

Dufour

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Liver transplant (LT) recipients are considered a vulnerable population amidst the COVID-19 pandemic. To date, available data have been heterogeneous and scarce. Therefore, we conducted a systematic literature review identifying English-language articles published in PubMed between November 2019 and 30th May 2021. We aimed to explore three areas: (1) outcome and clinical course; (2) immunological response after COVID-19 in LT recipients; and (3) vaccination response. After systematic selection, 35, 4, and 5 articles, respectively, were considered suitable for each area of analysis. Despite the heterogeneity of the reports included in this study, we found that gastrointestinal symptoms were common in LT recipients. The outcome of the LT population was not per se worse compared to the general population, although careful management of immunosuppressive therapy is required. While a complete therapy discontinuation is not encouraged, caution needs to be taken with use of mycophenolate mofetil (MMF), favoring tacrolimus (TAC) use. Although data conflicted about acquired immunity after SARS-CoV-2 infection, vaccine immunogenicity appeared to be low, suggesting that the level of surveillance should be kept high in this population.

show abstract

Section: Discussioncontrasting

confidence: 54%

COVID-19 in Liver Transplant Recipients: A Systematic Review

Becchetti

Gschwend

Dufour

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…The presence of metabolic syndrome (MS) post-LT was detected in 43-58% of recipients, compared to 30% of nontransplanted patients [12]. Metabolic syndrome is defined as in non-LT recipients if three or more of the following five criteria are met: waist circumference over 102 cm in men or 88 cm in women, blood pressure over 130/85 mmHg, fasting triglyceride (TG) level over 150 mg/dl, fasting HDL cholesterol level less than 40 mg/dl in men or 50 mg/dl in women and fasting blood sugar over 100 mg/dl [13].…”

Section: Metabolic Syndromementioning

confidence: 99%

“…Prolonged exposure to immunosuppressive drugs may increase the risk of metabolic complications because they are associated with all components of the MS. Corticosteroids, usually used in the early post-transplant phase, can act directly on pancreas beta cells increasing insulin resistance, obesity and hypertension; calcineurin inhibitors (CNIs) can affect the development of diabetes mellitus (particularly for tacrolimus), of hypertension (mainly cyclosporine) and hyperlipidemia (cyclosporine more than tacrolimus). Dyslipidemia is often related to the use of mammalian target of rapamycin (mTOR) inhibitors, whereas the use of anti-metabolites such as mycophenolate has fewer detrimental effects on MS related comorbidities [12,16]. Moreover, mTOR inhibitors impair also glucose metabolism and β-cell proliferation [17].…”

Section: Metabolic Syndromementioning

confidence: 99%

Long Term Follow-up of Liver Transplant Recipients: Considerations for Non-transplant Specialists

Iacob

Gheorghe

2021

JGLD

View full text Add to dashboard Cite

Patient and liver graft survival rates have improved significantly in the last decades, leading to complications mainly related to long-term immunosuppression. Prevention of, screening for metabolic syndrome, cardiovascular disease, de novo diabetes mellitus, renal dysfunction, and malignancies and their management are mandatory due to important causes of morbidity and mortality in this patient population. Quality of life (QoL) and functional benefits are clearly better compared to preoperative status; however, post-liver transplantation (LT) complications may impair and alter QoL scores. Individualized immunosuppression managed by transplant physicians and collaboration with other non-transplant specialists for recognition and treatment of medical complications and comorbidities after LT is the key to enhanced QoL and life expectancy of this patient population.

show abstract

“…However, it is not surprising that RP transplant patients were more obese, frequently displayed the metabolic syndrome, and were sicker than nontransplant RP patients, since a commonly known side effect of immunosuppression for transplant patients is metabolic syndrome and obesity. [22][23][24] Second, we also made important observations regarding differences in baseline characteristics between different transplant types before RP patients. Specifically, we found that the majority of transplant RP patients are kidney transplant PCa patients (44%), followed by heart (20%), liver (19%), and bone marrow (14%) in that order.…”

Section: Logistic Regression Models Testing In-hospital Complications Between Transplant Versus Nontransplant Rp Patientsmentioning

confidence: 99%

Increased risk of postoperative in‐hospital complications after radical prostatectomy in patients with prior organ transplant

et al. 2021

View full text Add to dashboard Cite

Background:To analyze postoperative, in-hospital, complication rates in patients with organ transplantation before radical prostatectomy (RP).Methods: From National Inpatient Sample (NIS) database (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) prostate cancer patients treated with RP were abstracted and stratified according to prior organ transplant versus nontransplant. Multivariable logistic regression models predicted in-hospital complications.Results: Of all eligible 202,419 RP patients, 216 (0.1%) underwent RP after prior organ transplantation. Transplant RP patients exhibited higher proportions of Charlson comorbidity index ≥2 (13.0% vs. 3.0%), obesity (9.3% vs. 5.6%, both p < 0.05), versus to nontransplant RP. Of transplant RP patients, 96 underwent kidney (44.4%), 44 heart (20.4%), 40 liver (18.5%), 30 (13.9%) bone marrow, <11 lung (<5%), and <11 pancreatic (<5%) transplantation before RP. Within transplant RP patients, rates of lymph node dissection ranged from 37.5% (kidney transplant) to 60.0% (bone marrow transplant, p < 0.01) versus 51% in nontransplant patients.Regarding in-hospital complications, transplant patients more frequently exhibited, diabetic (31.5% vs. 11.6%, p < 0.001), major (7.9% vs. 2.9%) cardiac complications (3.2% vs. 1.2%, p = 0.01), and acute kidney failure (5.1% vs. 0.9%, p < 0.001), versus nontransplant RP. In multivariable logistic regression models, transplant RP patients were at higher risk of acute kidney failure (odds ratio [OR]: 4.83), diabetic (OR: 2.81), major (OR: 2.39), intraoperative (OR: 2.38), cardiac (OR: 2.16), transfusion (OR: 1.37), and overall complications (1.36, all p < 0.001). No in-hospital mortalities were recorded in transplant patients after RP.Conclusions: Of all transplants before RP, kidney ranks first. RP patients with prior transplantation have an increased risk of in-hospital complications. The highest risk, relative to nontransplant RP patients appears to acute kidney failure.

show abstract

Medical management of metabolic and cardiovascular complications after liver transplantation

Cited by 32 publications

References 125 publications

COVID-19 in Liver Transplant Recipients: A Systematic Review

COVID-19 in Liver Transplant Recipients: A Systematic Review

Long Term Follow-up of Liver Transplant Recipients: Considerations for Non-transplant Specialists

Increased risk of postoperative in‐hospital complications after radical prostatectomy in patients with prior organ transplant

Contact Info

Product

Resources

About