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Gabrielli F, Golfieri L, Nascimbeni F, Andreone P, Gitto S. Metabolic Disorders in Liver Transplant Recipients: The State of the Art. J Clin Med 2024; 13:1014. [PMID: 38398327 PMCID: PMC10889804 DOI: 10.3390/jcm13041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Liver transplantation represents a chief therapeutic approach for acute liver failure, end-stage liver disease and hepatocellular carcinoma. Despite witnessing advancements in short- and medium-term survival over recent decades, attributed to refinements in surgical techniques and immunosuppressive protocols, long-term mortality remains impervious to modification. Notably, cardiovascular disease emerges as a predominant cause of mortality among liver transplant recipients. This trend is accentuated by the increasing prominence of non-alcoholic steatohepatitis-related cirrhosis as an indication for liver transplantation. Moreover, the administration of immunosuppressive agents is intricately linked to the degradation of the metabolic profile in liver transplant recipients, thereby contributing to the initiation or exacerbation of cardiovascular risk factors, such as hypertension, diabetes, and dyslipidaemia. In addition, the post-liver transplantation period is marked by a decline in lifestyle quality and a failure to acknowledge the psychological distress experienced by patients throughout the transplant process. These factors can precipitate a deterioration in the patient's metabolic profile, exacerbated by suboptimal therapeutic compliance. This narrative review aims to comprehensively address the principal metabolic disorders intricately associated with liver transplantation.
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Affiliation(s)
- Filippo Gabrielli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
- Department of Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Lucia Golfieri
- Clinical Psychology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Fabio Nascimbeni
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Pietro Andreone
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
- Postgraduate School of Allergology and Clinical Immunology, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Choudhary NS, Saraf N, Saigal S, Soin AS. Long-term Management of the Adult Liver Transplantation Recipients. J Clin Exp Hepatol 2021; 11:239-253. [PMID: 33746450 PMCID: PMC7953009 DOI: 10.1016/j.jceh.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
The survival of liver transplantation (LT) recipients has been improved remarkably in short-term. The major causes of mortality in long-term include nonimmunological causes such as cardiovascular, de novo malignancy, chronic kidney disease, and recurrence of primary disease. Rejection-related mortality is rare in the long-term after LT. We discuss nonrejection causes of long-term morbidity/mortality, risk factors, and management strategies in LT recipients. In addition, we discuss osteoporosis, contraception, and pregnancy in LT recipients.
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Key Words
- AIH, autoimmune hepatitis
- BMI, body mass index
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- CVD, cardiovascular disease
- DDLT, deceased donor liver transplantation
- DM, diabetes mellitus
- DNM, de novo malignancy
- HCV, hepatitis C virus
- HR, hazard ratio
- IUCD, Intrauterine contraceptive devices
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MDRD, Modification of Diet in Renal Disease
- MMF, mycophenolate
- MS, metabolic syndrome
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- PSC, primary sclerosing cholangitis
- PTDM, posttransplantation diabetes mellitus
- PTMS, posttransplantation metabolic syndrome
- SVR, sustained virological response
- cardiovascular disease
- de novo malignancy
- eGFR, estimated glomerular filtration rate
- mTORi, Mammalian target of rapamycin inhibitors
- osteoporosis
- pregnancy
- recurrence
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Affiliation(s)
- Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India
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Shen T, Zhuang L, Sun XD, Qi XS, Wang ZH, Li RD, Chang WX, Yang JY, Yang Y, Zheng SS, Xu X. Expert consensus on management of metabolic disease in Chinese liver transplant recipients. World J Gastroenterol 2020; 26:3851-3864. [PMID: 32774062 PMCID: PMC7385566 DOI: 10.3748/wjg.v26.i27.3851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/28/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
Metabolic disease, including diabetes mellitus, hypertension, dyslipidemia, obesity, and hyperuricemia, is a common complication after liver transplantation and a risk factor for cardiovascular disease and death. The development of metabolic disease is closely related to the side effects of immunosuppressants. Therefore, optimization of the immunosuppressive regimen is very important for the prevention and treatment of metabolic disease. The Chinese Society of Organ Transplantation has developed an expert consensus on the management of metabolic diseases in Chinese liver transplant recipients based on recent studies. Emphasis is placed on the risk factors of metabolic diseases, the effect of immunosuppressants on metabolic disease, and the prevention and treatment of metabolic diseases.
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Affiliation(s)
- Tian Shen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Dong Sun
- Department of Hepatobiliary and Pancreas Surgery, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Sheng Qi
- Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Zhi-Hui Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Rui-Dong Li
- Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wen-Xiu Chang
- Department of Nephrology, Tianjin First Center Hospital, Tianjin 300384, China
| | - Jia-Yin Yang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Shu-Sen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Xiao Xu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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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. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2018; 12:220-229. [PMID: 29366595 DOI: 10.1016/j.jash.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 12/29/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022]
Abstract
Arterial hypertension represents a common complication of immunosuppressive therapy after liver transplantation (LT). The aim of the study is to evaluate the prevalence and risk factors associated with hypertension after LT. From a cohort of 323 cirrhotic patients who underwent LT from 2008 to 2012, 270 patients were retrospectively evaluated, whereas 53 (16.4%) patients deceased. Hypertension was defined as blood pressure ≥140/90 mm Hg in at least two visits and/or the need for antihypertensive therapy. The prevalence of hypertension was 15% before LT and significantly increased up to 53% after LT (P < .001). Mean follow-up was 43 ± 19 months. In normotensive (NT) subjects at baseline, 35.9% developed sustained hypertension after LT, whereas 15.2% developed transient hypertension within the first month after LT, and then returned NT. The development of sustained hypertension after LT was related to the mammalian target of rapamycin inhibitor treatment (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.26-13.48; P = .02), alcoholic cirrhosis before LT (OR, 3.38; 95% CI, 1.44-8.09; P = .005), and new-onset hepatic steatosis after LT (OR, 2.13; 95% CI, 1.10-4.11; P = .02). Tacrolimus, the etiology and severity of liver disease, and other immunosuppressive regimens were not related to the development of hypertension after LT. In our cohort, the prevalence of arterial hypertension has increased up to 53% after LT, and metabolic comorbidities and immunosuppressive treatment with mammalian target of rapamycin inhibitors are the risk factors for the development of hypertension after LT.
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Affiliation(s)
- Cristina Di Stefano
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy.
| | - Ester Vanni
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Stefano Mirabella
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Ramy Younes
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valentina Boano
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elena Mosso
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elisabetta Nada
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valeria Milazzo
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Simona Maule
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Renato Romagnoli
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Franco Veglio
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
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Liu X, Wang B, Zhang X, Xiang J, Shi J, Tian M, Zhang A, Chang H, Qu K, Liu C, Yu L, Lv Y. Liver Transplantation Using Donation After Brain and Cardiac Death: A Single-Center Experience in China. Transplant Proc 2017; 48:1879-86. [PMID: 27569915 DOI: 10.1016/j.transproceed.2016.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Liver transplantation (LTx) using donation after brain and cardiac death (DBCD) has increased steadily in China. The aims of this study were to evaluate the outcomes of DBCD LTx and to assess its feasibility to expand the donor pool. METHODS We retrospectively analyzed the clinical characteristics of DBCD donors and recipients, survival of allografts and recipients, and prognostic factors in DBCD LTx recipients from March 2010 to December 2014 in our institution. RESULTS DBCD LTx (n = 102) were performed in our institution during the research period, and the successful donation rate was 26.0%. Mean warm ischemia time and cold ischemia time were 14.39 minutes and 5.29 hours, respectively. The overall and biliary complication rates were 45.1% and 16.7%, respectively. Donor age (P = .043), intra-operative blood loss (P = .048), and operation time (P = .045) were significantly different between the complication and non-complication groups. The 1-, 2-, and 3-year survival rates of patients and grafts were 88.0%, 84.6%, 84.6%, and 85.7%, 78.6%, and 78.6%, respectively. The 1- and 2-year overall survival rates of hepatocellular carcinoma patients were 91.9% and 80.5%, respectively whereas the recurrence-free survival rates were 84.9% and 77.2%, respectively. The patient and graft survival rates were not statistically different between the <55-year and ≥55 year groups, but complication rate was higher in the older group than in the younger group (P = .003). CONCLUSIONS The outcome of DBCD LTx is favorable in our institution, with careful donor and recipient selection and careful peri-operative management. DBCD is an optimized solution for organ shortage in today's China.
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Affiliation(s)
- X Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - B Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - X Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - J Xiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - J Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - M Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - A Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - H Chang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - K Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - C Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - L Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Y Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, PR China.
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Rutkowski DR, Reeder SB, Fernandez LA, Roldán-Alzate A. Surgical planning for living donor liver transplant using 4D flow MRI, computational fluid dynamics and in vitro experiments. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2017; 6:545-555. [PMID: 30094106 DOI: 10.1080/21681163.2017.1278619] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study used magnetic resonance imaging (MRI), computational fluid dynamics (CFD) modeling, and in vitro experiments to predict patient-specific alterations in hepatic hemodynamics in response to partial hepatectomy in living liver donors. 4D Flow MRI was performed on three donors before and after hepatectomy and models of the portal venous system were created. Virtual surgery was performed to simulate (1) surgical resection and (2) post-surgery vessel dilation. CFD simulations were conducted using in vivo flow data for boundary conditions. CFD results showed good agreement with in vivo data, and in vitro experimental values agreed well with imaging and simulation results. The post-surgery models predicted an increase in all measured hemodynamic parameters, and the dilated virtual surgery model predicted post-surgery conditions better than the model that only simulated resection. The methods used in this study have potential significant value for the surgical planning process for the liver and other vascular territories.
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Affiliation(s)
- David R Rutkowski
- Mechanical Engineering, University of Wisconsin-Madison Madison, WI, United States.,Radiology, University of Wisconsin-Madison Madison, WI, United States
| | - Scott B Reeder
- Radiology, University of Wisconsin-Madison Madison, WI, United States.,Medical Physics, University of Wisconsin-Madison Madison, WI, United States.,Biomedical Engineering, University of Wisconsin-Madison Madison, WI, United States.,Medicine, University of Wisconsin-Madison Madison, WI, United States.,Emergency Medicine, University of Wisconsin-Madison Madison, WI, United States
| | | | - Alejandro Roldán-Alzate
- Mechanical Engineering, University of Wisconsin-Madison Madison, WI, United States.,Radiology, University of Wisconsin-Madison Madison, WI, United States.,Biomedical Engineering, University of Wisconsin-Madison Madison, WI, United States
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Zimmermann A, Zobeley C, Weber MM, Lang H, Galle PR, Zimmermann T. Changes in lipid and carbohydrate metabolism under mTOR- and calcineurin-based immunosuppressive regimen in adult patients after liver transplantation. Eur J Intern Med 2016; 29:104-9. [PMID: 26775180 DOI: 10.1016/j.ejim.2015.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/02/2015] [Accepted: 12/28/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular disease is a leading cause of long-term mortality after liver transplantation (LT). Life long immunosuppression harbors the risk of metabolic alterations. We aimed to analyze the impact of calcineurin (CNI)-only containing regimen (group A) compared to mTOR-containing regimen (group B) on lipid and carbohydrate metabolism. PATIENTS/METHODS 92 adult patients after LT, University of Mainz (group A-78 patients, group B-14 patients; 65 M/27 F; mean age 59+/-10.2years; mean time from LT 5.8+/-5years). Clinical data, comorbidities, and medication were assessed. Fasting lipid profile including small dense LDLs (sdLDL) and oral glucose tolerance tests were performed. RESULTS Group B had significantly higher levels of total cholesterol (TC), LDL-cholesterol (LDL-C), triglycerides (TG) and sdLDL, with persistence of higher TC, TG, sdLDLs (mg/dl) after exclusion of patients under lipid lowering medication. Concentrations above the upper limits of normal were found: for LDL-C in 9% of group A/35.7% of group B (p=0.016); for TG: in 32.1% of group A/92.9% in group B (p=0.0001). A positive correlation between time since LT (years) and sdLDL (mg/dl) was found in group B (p=0.018). In patients without previously known diabetes, NODAT and impaired glucose tolerance developed in 27.9% of group A/44.4% of group B (n.s.). CONCLUSION Patients under mTOR-containing regimen are at higher risk to develop dyslipidemia with increased atherogenic sdLDLs compared to patients under CNI-only-containing regimen and display more frequently a dysglycemic status, with uncertain relevance for long-term cardiovascular risk. A careful monitoring after LT is needed to identify early metabolic risk and manage this appropriately.
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Affiliation(s)
- Anca Zimmermann
- Dept. of Endocrinology and Metabolic Diseases, 1st Medical Clinic, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Christina Zobeley
- Dept. of Gastroenterology and Hepatology, Transplant Hepatology, 1st Medical Clinic, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany
| | - M M Weber
- Dept. of Endocrinology and Metabolic Diseases, 1st Medical Clinic, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany
| | - H Lang
- Dept. for General, Visceral and Transplantation Surgery, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Peter R Galle
- Dept. of Gastroenterology and Hepatology, Transplant Hepatology, 1st Medical Clinic, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Tim Zimmermann
- Dept. of Gastroenterology and Hepatology, Transplant Hepatology, 1st Medical Clinic, University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany
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