Metabolic syndrome before liver transplantation: does it have an impact on post liver transplantation outcomes?

Abstract

Introduction: Metabolic syndrome (MS) and cardiovascular risk factors are commonin liver transplant (LT) candidates and recipients. Cardiovascular events and de novo tumours are increasingly common causes of mortality in liver transplant recipients. The aim of this study is (i) to assess the prevalence of MS in LT recipients and its growth over the years and (ii) if the presence of MS pre-LT is associated with a higher risk of post-LT cardiovascular events (CVE), de novo tumours or early and late survival. Patients and methods:Retrospective study that included LT recipients from January 2012 to December 2017. Baseline features (MS before LT and at 1year post-LT) and outcomes (CVE, de novo tumours and survival) were recorded.Results: 483 recipients were included, MS was present pre-LT in 20% with an increasing prevalence over time, from16% in 2012 to 34% in 2017 (p=0.025). One-year post-LT, an additional 12% had developed de novo MS .At a median of 56-months follow-up, 13% developed a CVE and 9% a de novo tumour. One and 5-yr survival rates were91% and 83 % in those with pre-LT MS and 93% and 85 % in those without (p=0.94).The presence of MS before LT was independently associated with a higher risk of post-LT CVE (HR: 2.66 IC (95%): 1.6-4.4 p< 0.001), but not with de novo tumors (p=0.94) nor early and late survival (p=0.58 and p=0.87). Conclusion:Pre-LT MS is increasing among LT candidates and is associated with a higher risk of post-LT morbidity CVE yet without affecting mortality.

De novo metabolic syndrome after liver transplantation: a meta-analysis on cumulative incidence, risk factors, and outcomes

“…Of the 15 included cohort studies, majority were retrospective (n = 14) and there was one prospective study. The studies were conducted in various countries including 4 in Italy, [30][31][32][33] 3 in Spain, [34][35][36] and one in the United States, [37] Australia, [38] Belgium, [39] Singapore, [40] China, [41] Israel, [42] Germany, [5] and India, [43] respectively. A total of 2683 LT recipients were included in this study, with 740 patients developing de novo PTMS.…”

De Novo Metabolic Syndrome 1 Year after Liver Transplantation and Its Association with Mid- and Long-Term Morbidity and Mortality in Liver Recipients

“…There is a paucity of scientific reports that provide evidence on the influence of new-onset MS on mid- and long-term prognoses in liver recipients. Those that exist suggest increased cardiovascular (CV) morbidity with no implications for survival rates and risk of de novo tumours [ 7 , 8 , 9 , 10 ].…”

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

“…SIRS has a precise clinical definition, which has been validated in large patient populations ( 15 – 17 ). In this context, it has been shown by several studies that patients with MetS and/or SIRS experience higher rates of morbidity, increased instances of postoperative morbidity including cardiovascular complications, and slower recovery of function across both cardiac and non-cardiac surgery ( 18 – 20 ). Last but not least, frailty assessment has acquired increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery ( 21 , 22 ).…”