Metabolic syndrome in liver transplant recipients: Prevalence and association with major vascular events

Authors

  • Marie Laryea,

    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Hepatology Services, Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Kymberly D. Watt,

    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Hepatology Services, Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Michele Molinari,

    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Department of Surgery, Halifax, Dalhousie University, Nova Scotia, Canada
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  • Mark J. Walsh,

    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Department of Surgery, Halifax, Dalhousie University, Nova Scotia, Canada
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  • Vivian C. McAlister,

    1. Multi-Organ Transplant Program, London Health Sciences Centre, London, Ontario, Canada
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  • Paul J. Marotta,

    1. Multi-Organ Transplant Program, London Health Sciences Centre, London, Ontario, Canada
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  • Bjorn Nashan,

    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Department of Surgery, Halifax, Dalhousie University, Nova Scotia, Canada
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  • Kevork M. Peltekian

    Corresponding author
    1. Multi-Organ Transplant Program, Capital District Health Authority, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
    2. Hepatology Services, Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
    • QEII-HSC VG Site 6-302, 1278 Tower Road, Halifax, NS, Canada B3H 2Y9
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    • Telephone: 1-902-473-2898; FAX: 1-902-473-2783


  • See Editorial on Page 1078

  • The findings of this study were presented in part at the annual meetings of the Canadian Association for the Study of the Liver (CASL) in Banff, Alberta, Canada, in March 2005 and the European Association for the Study of the Liver (EASL) in Vienna, Austria, in May 2006.

Abstract

Cardiac and cerebral vascular diseases are leading causes of morbidity and death in solid organ transplant recipients. Immunosuppressant drugs are associated with dyslipidemia, hypertension, and hyperglycemia, which along with obesity are the main features of metabolic syndrome. In the nontransplant population, metabolic syndrome is associated with increased risk for major vascular complications. We postulated that metabolic syndrome is common post–liver transplantation and plays a significant role leading to cardiac and cerebrovascular events. Our Multi-Organ Transplant Program database was reviewed for all liver transplant recipients between January 1998 and June 2004 with follow-up until December 2005. We adapted the 2001 National Cholesterol Education Program-Adult Treatment Panel III Guidelines to define posttransplantation metabolic syndrome (PTMS) as the presence at least 3 of the following: 1) obesity (body mass index >30 kg/m2); 2) serum triglyceride level ≥1.7 mmol/L; 3) high density lipoprotein level <1 mmol/L in men and <1.3 mmol/L in women; 4) hypertension; and 5) fasting plasma glucose ≥5.6 mmol/L. A total of 118 patients were included. Among them, 69 patients (58%) had PTMS. The mean (± standard deviation) time from transplant was 59 ± 21 months (no significant difference in patients with or without metabolic syndrome). Overall, patients with metabolic syndrome had a significantly higher average age, posttransplantation body mass index, fasting glucose, high-density lipoprotein levels, and serum triglycerides. There was no difference in creatinine, hemoglobin, or prednisone average dose between the 2 groups. There were 25 major vascular events affecting 21% of patients. There were significantly more vascular events in patients with metabolic syndrome posttransplantation than in those without (30% vs. 8%; P = 0.003) during the study period. In conclusion, the prevalence of metabolic syndrome post–liver transplant is significantly higher than that estimated in the general population. Metabolic syndrome appears to be associated with an increased risk of major vascular events in our liver transplant population. Liver Transpl 13:1109–1114, 2007. © 2007 AASLD.

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