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Schmidt K, Spann A, Khan MQ, Izzy M, Watt KD. Minimizing Metabolic and Cardiac Risk Factors to Maximize Outcomes After Liver Transplantation. Transplantation 2024; 108:1689-1699. [PMID: 38060378 DOI: 10.1097/tp.0000000000004875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Cardiovascular disease (CVD) is a leading complication after liver transplantation and has a significant impact on patients' outcomes posttransplant. The major risk factors for post-liver transplant CVD are age, preexisting CVD, nonalcoholic fatty liver disease, chronic kidney disease, and metabolic syndrome. This review explores the contemporary strategies and approaches to minimizing cardiometabolic disease burden in liver transplant recipients. We highlight areas for potential intervention to reduce the mortality of patients with metabolic syndrome and CVD after liver transplantation.
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Affiliation(s)
- Kathryn Schmidt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Ashley Spann
- Division of Gastroenterology and Hepatology, Vanderbilit University, Nashville, TN
| | - Mohammad Qasim Khan
- Division of Gastroenterology and Hepatology, University of Western Ontario, London, ON, Canada
| | - Manhal Izzy
- Division of Gastroenterology and Hepatology, Vanderbilit University, Nashville, TN
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Bui AT, Chaudhari R, Bhati C, Wolver S, Patel S, Boyett S, Evans MC, Kamal H, Patel V, Forsgren M, Sanyal AJ, Kirkman D, Siddiqui MS. Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients. Liver Transpl 2024; 30:192-199. [PMID: 37146168 DOI: 10.1097/lvt.0000000000000169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/07/2023] [Indexed: 05/07/2023]
Abstract
Metabolic flexibility is the ability to match biofuel availability to utilization and is inversely associated with increased metabolic burden among liver transplant (LT) recipients. The present study evaluated the impact of metabolic flexibility on weight gain following LT. LT recipients were enrolled prospectively (n = 47) and followed for 6 months. Metabolic flexibility was measured using whole-room calorimetry and is expressed as a respiratory quotient (RQ). Peak RQ represents maximal carbohydrate metabolism and occurs in the post-prandial state, while trough RQ represents maximal fatty acid metabolism occurring in the fasted state. The clinical, metabolic, and laboratory characteristics of the study cohort of lost weight (n = 14) and gained weight (n = 33) were similar at baseline. Patients who lost weight were more likely to reach maximal RQ (maximal carbohydrate oxidation) early and rapidly transitioned to trough RQ (maximal fatty acid oxidation). In contrast, patients who gained weight had delayed time to peak RQ and trough RQ. In multivariate modeling, time to peak RQ (β-coefficient 0.509, p = 0.01), time from peak RQ to trough RQ (β-coefficient 0.634, p = 0.006), and interaction between time to peak RQ to trough RQ and fasting RQ (β-coefficient 0.447, p = 0.02) directly correlated with the severity of weight gain. No statistically significant relationship between peak RQ, trough RQ, and weight change was demonstrated. Inefficient transition between biofuels (carbohydrates and fatty acids) is associated with weight gain in LT recipients that is independent of clinical metabolic risk. These data offer novel insight into the physiology of obesity after LT with the potential to develop new diagnostics and therapeutics.
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Affiliation(s)
- Anh T Bui
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Rahul Chaudhari
- Division of Gastroenterology and Hepatology, VCU, Richmond, Virginia, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Maryland, USA
| | - Susan Wolver
- Department of Internal Medicine, VCU, Richmond, Virginia, USA
| | - Samarth Patel
- Division of Gastroenterology and Hepatology, Lehigh Valley Hospital-Cedar Crest, Pennsylvania, USA
| | - Sherry Boyett
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Marie Claire Evans
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Hiba Kamal
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Vaishali Patel
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Mikael Forsgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Arun J Sanyal
- Division of Gastroenterology and Hepatology, VCU, Richmond, Virginia, USA
| | - Danielle Kirkman
- Department of Kinesiology and Health Sciences, VCU, Richmond, Virginia, USA
| | - Mohammad Shadab Siddiqui
- Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
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Lim WH, Ng CH, Tan D, Tseng M, Xiao J, Yong JN, Zeng RW, Cho E, Tay P, Ang CZ, Koh JH, Teng M, Syn N, Kow A, Huang DQ, Tan EX, Rinella ME, Sanyal A, Muthiah M, Siddiqui MS. Natural history of NASH cirrhosis in liver transplant waitlist registrants. J Hepatol 2023; 79:1015-1024. [PMID: 37307997 DOI: 10.1016/j.jhep.2023.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS Non-alcoholic steatohepatitis (NASH) cirrhosis is rapidly growing as an indication for liver transplant(ation) (LT). However, the natural history of NASH cirrhosis among LT waitlist registrants has not been established. The present study aimed to define the natural history of NASH cirrhosis using the Scientific Registry of Transplant Recipients database. METHODS The study cohort comprised patients registered on the LT waitlist between 1/1/2016 to 12/31/2021. The primary outcomes included probability of LT and waitlist mortality, comparing NASH (n = 8,120) vs. non-NASH (n = 21,409) cirrhosis. RESULTS Patients with NASH cirrhosis were listed with lower model for end-stage liver disease (MELD) scores despite bearing a greater burden of portal hypertension, especially at lower MELD scores. The overall transplant probability in LT waitlist registrants with NASH [vs. non-NASH] cirrhosis was significantly lower at 90 days (HR 0.873, p <0.001) and 1 year (HR 0.867, p <0.001); this was even more pronounced in patients with MELD scores >30 (HR 0.705 at 90 days and HR 0.672 at 1 year, p <0.001 for both). Serum creatinine was the key contributor to MELD score increases leading to LT among LT waitlist registrants with NASH cirrhosis, while bilirubin was in patients with non-NASH cirrhosis. Finally, waitlist mortality at 90 days (HR 1.15, p <0.001) and 1 year (1.25, p <0.001) was significantly higher in patients with NASH cirrhosis compared to those with non-NASH cirrhosis. These differences were more pronounced in patients with lower MELD scores at the time of LT waitlist registration. CONCLUSIONS LT waitlist registrants with NASH cirrhosis are less likely to receive a transplant compared to patients with non-NASH cirrhosis. Serum creatinine was the major contributor to MELD score increases leading to LT in patients with NASH cirrhosis. IMPACT AND IMPLICATIONS This study provides important insights into the distinct natural history of non-alcoholic steatohepatitis (NASH) cirrhosis among liver transplant (LT) waitlist registrants, revealing that patients with NASH cirrhosis face lower odds of transplantation and higher waitlist mortality than those with non-NASH cirrhosis. Our study underscores the significance of serum creatinine as a crucial contributor to model for end-stage liver disease (MELD) score in patients with NASH cirrhosis. These findings have substantial implications, emphasizing the need for ongoing evaluation and refinement of the MELD score to more accurately capture mortality risk in patients with NASH cirrhosis on the LT waitlist. Moreover, the study highlights the importance of further research investigating the impact of the implementation of MELD 3.0 across the US on the natural history of NASH cirrhosis.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Darren Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Tseng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Elina Cho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phoebe Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chong Zhe Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Hong Koh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alfred Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital Singapore, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Eunice Xx Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mary E Rinella
- Division of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
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Chavez DA, Evans MC, Bohmke NJ, Kamal H, Tran LQ, Bhati C, Wolver S, Siddiqui MS, Kirkman DL. Postoperative association between impaired renal function and vascular dysfunction in liver transplant recipients. Liver Transpl 2023; 29:340-342. [PMID: 37160055 PMCID: PMC9935544 DOI: 10.1002/lt.26572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Domenico A Chavez
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Marie-Claire Evans
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Natalie J Bohmke
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Hiba Kamal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Loan Quynh Tran
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Chandra Bhati
- Division of Transplant Surgery, Department of Surgery , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Susan Wolver
- Division of General Internal Medicine, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Mohammad S Siddiqui
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences , Virginia Commonwealth University , Richmond , Virginia , USA
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