Incidence and Risk Factors for Diabetes, Hypertension and Hyperlipidemia after Liver Transplantation

Mohamed Saad HASHIM, Maha Alsabaawy, Sameh Afify, Gaser El-Azab, Nabil Omar

Abstract


Introduction and aim: Post-liver transplant recipients present a vast array of metabolic disturbances in the post-transplant period which impact on their morbidity and mortality. Post-transplant diabetes and hypertension were associated with increased risks of graft failure, infection, cardiovascular disease, and death. Therefore, predicting and preventing post-transplant metabolic complications would be a compelling objective for improving care of post-transplant recipients. The aim of this study was to identify the incidence and risk factors of metabolic complications after liver transplantation.

Methods: Incidence and risk factors for new onset arterial hypertension, diabetes mellitus and hyperlipidemia were assessed progressively in 100 post- liver transplant recipients at least one year after transplantation (91% male; mean age 52 ± 7.7 y). Risk factors were assessed using logistic regression analysis according to demographic, clinical and laboratory variables.

Results: The incidence of hypertension was 38.6%; diabetes, 39.7% and hyperlipidemia, 19% at one year post-liver transplantation (LTX). Independent risk factors for new onset of hypertension were family history of hypertension (OR: 4.85; 95% CI: 3.04-7.74), and cyclosporine use (OR: 6.33; 95%CI: 2.36-16.96). Risk factor for new onset of diabetes were HCV infection (OR: 2.54; 95%CI: 0.84-7.72) and cyclosporine use (12.63; 95%CI: 3.06-52.09). The incidence of hyperlipidemia after LTX was related to the use of cyclosporine (OR: 1.56; 95%CI: 1.04-1.98), or tacrolimus (OR: 1.34; 95%CI: 1.02-1.67).

Conclusion: LTX was associated with significantly increased rates of hypertension, diabetes and hyperlipidemia. Furthermore, the incidences of these disorders were related to immunosuppressive therapy.


Keywords


Liver Transplantation; Immunosuppression; calcineurin inhibitors; metabolic syndrome; hypertension; diabetes mellitus; and hyperlipidemia.

References


REFERENCES

REFERENCES

Alqahtani SA and Larson AM. Adult liver transplantation in the USA. Curr Opin Gastroenterol 2011; 27: 240-247. PMID: 21378559 DOI: 10.1097/MOG.0b013e3283457d5d.

Varma V, Mehta M, Kumaran V, Nundy S. Indications and Contraindications for Liver Transplantation. Int J Hepatol 2011; 2011: 121862. PMID: 22007310 DOI: 10.4061/2011/121862.

Anastácio LR, Ribeiro Hde S, Ferreira LG, Lima AS, Vilela EG, Toulson Davisson Correia MI. Incidence and risk factors for diabetes, hypertension and obesity after liver transplantation. Nutr Hosp 2013; 28: 643-648. PMID: 23848083 DOI: 10.3305/nh.2013.28.3.6193

Luntai ME, Grancini V, Agnelli F, Gatti S, Masserini B, Zimbalatti D, Pugliese G, Rossi G, Donato MF, Colombo M, Beck-Peccoz P, Orsi E. Metabolic syndrome after transplantation: Short-term prevalence and pre-and post-operative risk factors. Dig Liver Dis 2013; 45: 833-839. PMID: 23816695 DOI: 10.1016/j.dld.2013.03.009

Perito ER, Lau A, Rhee S, Roberts JP, Rosenthal P. Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systemic review. Liver transpl 2012; 18: 1009-1028. PMID: 22641460 DOI: 10.1002/lt.23478

American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes care 2013; 36 (suppl 1): s11-s66. PMID: 23264425 DOI: 10.2337/dc13-S067

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, Roccella EJ. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-1252. PMID: 12748199 DOI: 10.1001/jama.289.19.2560

EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2015; 64:433 – 485. PMID: 26597456 DOI: 10.1016/j.jhep.2015.10.006

Lunati ME, Grancini V, Agnelli F, Gatti S, Masserini B, Zimbalatti D, Pugliese G, Rossi G, Donato MF, Colombo M, Beck-Peccoz P, Orsi E. Metabolic syndrome after liver transplantation: short-term prevalence and pre- and post-operative risk factors. Dig Liver Dis 2013; 45:833-9. PMID: 23816695 DOI: 10.1016/j.dld.2013.03.009

Anastácio LR, Ribeiro Hde S, Ferreira LG, Lima AS, Vilela EG, Toulson Davisson Correia MI. Incidence and risk factors for diabetes, hypertension and obesity after liver transplantation. Nutr Hosp 2013; 28: 643-8. PMID: 23848083 DOI: 10.3305/nh.2013.28.3.6193

Tong MS, Chai HT, Liu WH, Chen CL, Fu M, Lin YH, Lin CC, Chen SM, Hang CL. Prevalence of hypertension after living-donor liver transplantation: a prospective study. Transplant Proc 2015; 47: 445-50. PMID: 25769588 DOI: 10.1016/j.transproceed.2014.10.050

Hryniewiecka E, Pilecki T, Zieniewicz K, Paczek L. Circadian and short-term blood pressure abnormalities after liver transplantation. Clin Exp Hypertens 2018; 40: 730-733. PMID: 29420076 DOI: 10.1080/10641963.2018.1431248

Di Stefano C, Vanni E, Mirabella S, Younes R, Boano V, Mosso E, Nada E, Milazzo V, Maule S, Romagnoli R, Salizzoni M, Veglio F, Milan A. Risk factors for arterial hypertension after liver transplantation. J Am Soc Hypertens 2018; 12:220-229. PMID: 29366595 DOI: 10.1016/j.jash.2018.01.002

Neal DA, Brown MJ, Wilkinson IB, Alexander GJ. Mechanisms of hypertension after liver transplantation. Transplantation 2005; 79(8):935-940. PMID: 15849546 DOI: 10.1097/01.tp.0000158738.00927.65

Curtis JJ. Hypertensinogenic mechanism of the calcineurin inhibitors. Curr Hypertens Rep 2002; 4: 377-380. PMID: 12217256 DOI: 10.1007/s11906-002-0067-5

Neal DA, Gimson AE, Gibbs P, Alexander GJ. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl 2001; 7: 533-539. PMID: 11443583 DOI: 10.1053/jlts.2001.24637

Canzanello VJ, Schwartz L, Taler SJ, Textor SC, Wiesner RH, Porayko MK, Krom RA. Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506). Liver Transpl Surg 1997; 3: 1-9. PMID: 9377752 DOI: 10.1002/lt.500030101

Manzarbeitia C, Reich DJ, Rothstein KD, Braitman LE, Levin S, Munoz SJ. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl 2001; 7: 93-99. PMID: 11172391 DOI: 10.1053/jlts.2001.21289

Pratschke J, Neuhaus R, Tullius SG, Haller GW, Jonas S, Steinmueller T, Bechstein WO, Neuhaus P. Treatment of cyclosporine-related adverse effects by conversion to tacrolimus after liver transplantation. Transplantation 1997; 64: 938-940. PMID: 9326428 DOI: 10.1097/00007890-199709270-00029

Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 2002; 96: 23-43. PMID: 12441176 DOI: 10.1016/s0163-7258(02)00297-8

Lladó L, Xiol X, Figueras J, Ramos E, Memba R, Serrano T, Torras J, Garcia-Gil A, Gonzalez-Pinto I, Castellote J, Baliellas C, Fabregat J, Rafecas A. Immunosuppression without steroids in liver transplantation is safe and reduces infection and metabolic complications: results from a prospective multicenter randomized study. J Hepatol 2006; 44: 710-716. PMID: 16487622 DOI: 10.1016/j.jhep.2005.12.010

Kallwitz ER. Metabolic syndrome after liver transplantation: Preventable illness or common consequence? World J Gastroenterol 2012; 18: 3627–3634. PMID: 22851856 DOI: 10.3748/wjg.v18.i28.3627

Anastácio LR, Lima AS, Toulson Davisson Correia MI. Metabolic syndrome and its components after liver transplantation: incidence, prevalence, risk factors, and implications. Clin Nutr 2010; 29:175-9. PMID: 19783330 DOI: 10.1016/j.clnu.2009.08.008

Gisbert C, Prieto M, Berenguer M, Bretó M, Carrasco D, de Juan M, Mir J, Berenguer J. Hyperlipidemia in liver transplant recipients: prevalence and risk factors. Liver Transpl Surg 1997; 3: 416-422. PMID: 9346772 DOI: 10.1002/lt.500030409

Dehghani SM, Taghavi SA, Eshraghian A, Gholami S, Imanieh MH, Bordbar MR, Malek-Hosseini SA. Hyperlipidemia in Iranian liver transplant recipients: prevalence and risk factors. J Gastroenterol 2007; 42(9):769-74. PMID: 17876547 DOI: 10.1007/s00535-007-2092-2

Charco R, Cantarell C, Vargas V, Capdevila L, Lázaro JL, Hidalgo E, Murio E, Margarit C. Serum cholesterol changes in long-term survivors of liver transplantation: a comparison between cyclosporine and tacrolimus therapy. Liver Transpl Surg 1999; 5: 204-208. PMID: 10226111 DOI: 10.1002/lt.500050303

Neff GW, Montalbano M, Tzakis AG. Ten years of sirolimus therapy in orthotopic liver transplant recipients. Transplant Proc 2003; 35: 209S-216S. PMID: 12742498 DOI: 10.1016/s0041-1345(03)00217-3

Agarwal A and Prasad G. Post-transplant dyslipidemia: Mechanisms, diagnosis and management. World J Transplant 2016; 6: 125–134. PMID: 27011910 DOI: 10.5500/wjt.v6.i1.125

Riella LV, Gabardi S, Chandraker A. Dyslipidemia and its therapeutic challenges in renal transplantation. Am J Transplant 2012; 12:1975–1982. PMID: 22578270 DOI: 10.1111/j.1600-6143.2012.04084.x


Full Text: PDF HTML

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.