Posttransplant metabolic syndrome: An epidemic waiting to happen

Pagadala, Mangesh; Dasarathy, Srinivasan; Eghtesad, Bijan; McCullough, Arthur J.

doi:10.1002/lt.21952

Cited by 143 publications

(144 citation statements)

References 50 publications

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“…64 It has been associated with increased risks of cardiovascular disease, cardiovascular death, liver-related death, and overall mortality. [65][66][67] Among the various causative factors for development of post liver transplant metabolic syndrome, effects of immunosuppression (calcineurin inhibitors, mTOR inhibitors and steroids) are the most important. All these drugs cause hyperglycemia (gluconeogenesis or less peripheral glucose utilization), less insulin production and dyslipidemia.…”

Section: Kidney Injury and Immunosuppressionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

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Section: Kidney Injury and Immunosuppressionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…Childhood obesity and hypertension are also related to early death. 10 Several studies have explained the increased rates of metabolic syndrome in posttransplant patients; however, most of these were conducted in adult patients. Because Nemazee Hospital is the 4th largest liver transplant center in the world and a massive number of transplants are done every year in this center, we conducted a survey to find the incidence of metabolic syndrome in children after liver transplant in our center.…”

Section: Farzad Vafaei Et Al/experimental and Clinical Transplantatiomentioning

confidence: 99%

“…8 In addition, some cohort studies on pediatric patients have shown that metabolic syndrome in childhood increases the risk of cardiovascular disease in adulthood. 9 Obesity in childhood, hypertension, and glucose intolerance correlate with premature death, 10 whereas immediate diagnosis and treatment of these complications will prevent other similar long-term problems. 11,12 Throughout Iran, Shiraz city has the best active center for liver transplant procedures for pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Vafaei

Dehghani²,

Malekhoseini³

et al. 2018

Exp Clin Transplant

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Objectives: Metabolic syndrome components, such as being overweight or having hypertension, hyperlipidemia, or diabetes mellitus, are common complications after liver transplant in pediatric patients with probable multifactorial causes and increase the risk of cardiovascular complications in adulthood. In this study, our aim was to evaluate the prevalence of these components both before and after transplant surgery. Materials and Methods: Our study included all children having liver transplant at our institution over a period of 20 years who were under 18 years old and had at least 6 months of posttransplant follow-up. Prevalence of metabolic syndrome components and pretransplant and posttransplant laboratory data of patients were evaluated. Results: Over the 20-year study period, 391 liver transplant patients were included in our study, in which 167 were girls (42.7%) and 224 were boys (57.3%). Patients showed a posttransplant hyperlipidemia rate of 7.5%, hyperglycemia rate of 22%, hypertension rate of 9.6%, and metabolic syndrome rate of 50.2%. Pretransplant, the rate of patients with metabolic syndrome was 10.5%. Conclusions: Our study confirmed that the prevalence of metabolic syndrome in patients after liver transplant increases dramatically and should be explored with further research.

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“…In addition, recent studies have reported a significantly higher post-LT prevalence of MS ranging from 40% to 58% at 1 year compared to the general population. 3,4 Interestingly, the higher incidence of MS in LT recipients is not only seen in patients transplanted for nonalcoholic fatty liver disease (NAFLD) but also in patients transplanted for other indications.…”

Section: See Article On Page 889mentioning

confidence: 99%

Cardiovascular diseases after liver transplantation—a still emerging and unsolved problem!

Graziadei

Cárdenas

2015

Liver Transpl

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The outcome of adult liver transplantation (LT) recipients has improved incrementally over the last 4 decades with patient survival rates of approximately 90% at 1 year and 70%-80% at 5 to 10 years. The greatest progress has been mainly achieved in the early postoperative period because of improved selection criteria, advances in surgical techniques, and improvements in immunosuppressive and anti-infective drug therapies. The survival rates beyond 1 year, however, have remained relatively stagnant during the same time period. This fact as well as the growing number of long-term survivors has increased the importance of understanding the underlying mechanisms and risk factors for intermediate and late post-LT complications and death attributed to medical complications. Beside de novo malignancies, cardiovascular diseases (CVDs) have emerged as one the leading causes of non-graftrelated morbidity and mortality in LT recipients, accounting for 12%-16% of deaths. 1Several studies have shown that LT recipients have a significantly increased risk of cardiovascular (CV) events and deaths compared to an age-and sexmatched general population. This elevated CVD rate ranges from 9% at 5 years to up to 25% at 10 years. 2The high prevalence of metabolic syndrome (MS) and its clinical features, in particular insulin-resistant (type 2) diabetes, obesity (body mass index >30 kg/ m 2 ), dyslipidemia, and arterial hypertension, either alone or in combination, are the main contributors to the high risk of CVD in the post-LT period. It has been shown that patients with post-LT MS are approximately 4 times more likely to have a CV event than recipients without MS. In addition, recent studies have reported a significantly higher post-LT prevalence of MS ranging from 40% to 58% at 1 year compared to the general population. 3,4 Interestingly, the higher incidence of MS in LT recipients is not only seen in patients transplanted for nonalcoholic fatty liver disease (NAFLD) but also in patients transplanted for other indications.NAFLD, the hepatic manifestation of MS, is the leading cause of abnormal liver function tests in the Western world. Fatty liver disease leads to a spectrum of liver diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and ultimately liver cirrhosis. End-stage liver disease secondary to NASH cirrhosis has become the second most common cause for LT and presumably will be the leading indication in the next decade. This is of further importance as current studies have shown that CVDs are especially overrepresented in patients with NASH-related liver disease, 5 independent of common underlying risk factors, such as MS and diabetes. 6 Several studies have determined the cumulative risk of CVD after LT. Independent predictive factors of CVD are older age at transplantation, male sex, preexisting cardiac disease, and components of the MS. [7][8][9]

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Posttransplant metabolic syndrome: An epidemic waiting to happen

Cited by 143 publications

References 50 publications

Current Status of Immunosuppression in Liver Transplantation

Current Status of Immunosuppression in Liver Transplantation

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Cardiovascular diseases after liver transplantation—a still emerging and unsolved problem!

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