Metabolic syndrome in liver transplantation. Relation to etiology and immunosuppression

Excessive weight gain, hypertension, hyperlipidaemia and diabetes are frequently observed in patients submitted to liver transplantation (LTx). These alterations are probably multifactorial in origin, and cluster to generate a metabolic syndrome, increasing the risk of cardiovascular events. We assessed the prevalence of metabolic syndrome (Adult Treatment panel III criteria) in 296 LTx-patients in the course of regular follow-up, at least six months after transplant (median, 39 months). Several pre- and pots-LTx data were collected to identify the factors associated with the presence of metabolic syndrome. In a subset of 99 patients, insulin resistance was measured by the homeostasis model assessment (HOMA). High blood pressure was present in 53% of cases, hyperlipidemia in 51%, high glucose in 37%, enlarged waist circumference in 32.5%. Overall, the metabolic syndrome (three or more of the above features) was present in 44.5% of cases. Insulin resistance (HOMA > 2.7) was observed in 41% of cases. Hypertension and hyperlipidemia were more frequent in subjects on cyclosporine than in tacrolimus-treated cases, while the type of immunosuppressive drug had no effect on the prevalence of diabetes, enlarged waist and metabolic syndrome. In a logistic regression analysis, only pre-LTx BMI (OR, 1.20), BMI increase (OR, 1.18) and pre-LTx diabetes (OR, 2.36) predicted the metabolic syndrome; age, gender, etiology of liver disease, time from LTx, type of immunosuppressive drug, previous hepatocellular carcinoma were rejected from the model. Disorders related to metabolic syndrome are frequent in LTx patients, and are related to both pre-LTx conditions and to weight gain. Weight control is mandatory in LTx patients to prevent risk factors of premature atherosclerosis.