Post-transplant Metabolic Syndrome Research Articles

Risk Factors of Metabolic Syndrome among Post Living Donor Liver Transplant Egyptian Recipients: Single Center Study

Abstract Background For more than two decades, liver transplantation (LT) has been accepted as the most effective treatment for end-stage liver disease. However, complications following LT significantly affect the quality of life in long-term survival and metabolic syndrome (MS) is now considered to be the most common long-term complication after LT and has been increasing recently with an incidence of 50-60%. Aim of the Study To identify both pre-transplant and post-transplant risk factors which contribute to post-transplant MS (PTMS) among Egyptian recipients. Methods This study is retrospective prospective descriptive in nature. It was held at the Ain Shams Center for Organ Transplant (ASCOT), Ain Shams University Specialized Hospital with a total of 233 adult Egyptian patients who underwent living donor liver transplant (LDLT) from January 2010 through December 2020 were enrolled. Their data were extracted in detail from the medical records and were retrospectively analyzed. Results Our study has demonstrated that the recipient’s age (being old age), the presence of pre-transplant DM, the recipient being overweight prior to transplant, and the etiology of liver disease that served as an indication for liver transplant, especially cryptogenic cirrhosis, as well as the use of immunosuppressive drugs, mTOR inhibitors, in particular, were all strongly associated with the development of PTMS. However, only the presence of pre-transplant DM, the recipient being overweight prior to transplant, and the use of immunosuppressive drugs, mTOR inhibitors (Everolimus/Sirolimus), in particular, were considered independent risk factors of PTMS. Conclusion Early recognition and modification of risk factors of metabolic syndrome -if modifiable- would facilitate prevention of PTMS, which may reduce its prevalence among transplanted patients.

Changes in nutritional status and the development of obesity and metabolic syndrome following pediatric heart transplantation.

Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre-operative nutrition status has been shown to affect post-operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long-term in the post-transplant period. A single-center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1-year, and 3-year follow-up post-transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z-score, were utilized in secondary analyses. Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3-year follow-up. No underweight patients at listing became overweight/obese at follow-up. Of patients who were overweight/obese at listing, 88% maintained that status at 3-year follow-up. Overweight/obese status at listing, 1-year, and 3-year post-transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post-transplant metabolic syndrome. The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities.

Physical activity and its impact on cardiovascular health in pediatric kidney transplant recipients

BackgroundCardiovascular (CV) morbidity after kidney transplantation (KTx) in childhood is of increasing importance. In light of a high prevalence of CV risk factors, protective measures such as physical activity (PA) come into focus. Our aim was to comprehensively assess PA in pediatric KTx recipients and evaluate its impact on CV health.MethodsForty-eight patients were assessed for frequency, duration, intensity, and setting of PA using the “Motorik–Modul” PA questionnaire. Walking-based activity was measured by accelerometer in a subgroup (n = 23). CV risk factors and subclinical CV organ damage were determined. The impact of PA on CV parameters was analyzed using linear regression models.ResultsFifty-two percent of pediatric KTx recipients did not reach WHO recommended PA level; 54% did not engage in PA with vigorous intensity (VPA). Twenty-nine percent indicated an extremely inactive lifestyle (< 120 min/week of moderate to vigorous intensity PA, MVPA). Compared to the healthy German KiGGS cohort, KTx recipients specifically lacked engagement in sport activities (KTx: 129 min/week; 95%CI, 97–162 vs. KiGGS, 242 min/week; 95%CI, 230–253). VPA was associated with lower systolic blood pressure (p = 0.024) and resting heart rate (p = 0.005), MVPA with fewer components of the post-transplant metabolic syndrome (p = 0.037), and better left ventricular diastolic function (p = 0.006).ConclusionsA considerable lack of PA, especially VPA, exists in young KTx recipients. PA was positively associated with important parameters of CV health. While long-term CV protection through PA seems promising in pediatric KTx recipients, specific educational approaches are most likely needed to increase patients’ engagement in sport activities.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

De novo metabolic syndrome after liver transplantation: a meta-analysis on cumulative incidence, risk factors, and outcomes.

Post-transplant metabolic syndrome (PTMS) has been associated with increased cardiovascular risk which significantly impacts the morbidity and mortality rates of liver transplant (LT) recipients. This study sought to conduct a meta-analysis and systematic review on the cumulative incidence, risk factors, and cardiovascular outcomes associated with de novo PTMS.Medline and Embase were searched for articles describing the incidence, risk factors, and cardiovascular outcomes of de novo PTMS. Meta-analysis of proportions was conducted to calculate incidence. Conventional pairwise analysis using random effects model was used to tabulate OR and hazard ratio for risk factors and cardiovascular outcomes, respectively. Fifteen studies involving 2683 LT recipients were included. Overall rate of de novo PTMS was 24.7% (CI: 18.0%-32.9%) over a mean follow-up period of 15.3 months and was highest in patients with NAFLD (60.0%, CI: 52.0%-67.5%) compared with other liver diseases. Older age (OR: 1.05, CI: 1.01-1.09, p = 0.02) and pre-LT type II diabetes mellitus (OR: 5.00, CI: 4.17-5.99, p < 0.01) were predictive factors of de novo PTMS. Patients with de novo PTMS had significantly higher likelihood of cardiovascular disease events compared with those who did not (hazard ratio: 2.42, CI: 1.54-3.81, p < 0.01). De novo PTMS is a common complication and is significantly associated with increased cardiovascular disease morbidity. High-risk patients such as elderly recipients, those with pre-LT type II diabetes mellitus, or NASH-related cirrhosis should undergo routine screening to allow timely intervention.

Metabolic syndrome after liver transplant in patients at the specialized Center San Vicente Fundación, Rionegro, Antioquia, Colombia, 2013-2017.

Motivation for the study: there is a lack of studies in Latin America on the frequency of metabolic syndrome in patients who receive liver transplants. Main findings: two-thirds (66%) of patients who received liver transplantation between 2013 and 2017 at the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, subsequently presented metabolic syndrome. Implications: this study confirms that liver transplant recipients very frequently develop metabolic syndrome; however, the frequency found by this study (66%) was almost double that reported in other regions of the world, suggesting that patients from the Specialized Center San Vicente Fundación de Rionegro, Antioquia, Colombia, may present some additional condition. The medical records of all liver transplant patients attended at the Centro Especializado San Vicente Fundación between January 2013 and June 2017 were reviewed in order to determine the frequency of post-transplant metabolic syndrome (MS). We collected sociodemographic data, pathological history, toxicological history, complications, and ATP III criteria in a validated instrument. The statistical analysis was carried out with OpenEpi 3.01; p<0.05 was considered as statistically significant. Of the 102 reviewed medical records, 73 met the inclusion criteria (no MS diagnosis prior to transplant and complete information for the instru-ment) and were analyzed. Most patients were male (59%), older adults (64%) and married (62%). The frequency of MS after liver transplant was 66%. The association between MS and history of hypertension and diabetes was significant. We confirmed that MS is a frequent complication in liver transplant recipients and that history of hypertension and diabetes are the most frequent associated factors.

S1359 Post-Liver Transplant Metabolic Changes After One Year

Introduction: Elevations in HbA1c and BMI preoperatively and postoperatively are associated with post-transplant complications that impact long-term morbidity and mortality. The aim of this study is to evaluate the impact of transplant indications and demographic background on postoperative changes in HbA1c and BMI. Understanding factors associated with elevations in HbA1c and BMI can help determine at-risk patient groups. Methods: We performed an IRB-approved retrospective study. We obtained records of patients who underwent liver transplantation at Thomas Jefferson University Hospital from January 2002 to December 2020. We analyzed changes in BMI/HbA1c at transplant and one year post-transplant by age, race, gender, and indication for transplant using STATA statistical software 14.2. Results: Of the 100 liver transplant patients included in our study, 57 (63.3%) were male, and 33 (36.7%) were female. The average age was 63.26 years (61.13- 65.38, 95% CI), and the mean BMI and HbA1c at the time of transplant were 31.01 kg/m2(29.90-32.13, 95% CI) and 6.26 (5.89-6.62, 95% CI), respectively. There was no statistically significant (P >0.05) change in preoperative and one year postoperative BMI in transplant patients who had the following indications: NASH, Alcohol Cirrhosis, HCV, HBV, PSC, HCC, and cryptogenic cirrhosis. There was also no significant change in preoperative and one year postoperative BMI when stratifying patients by gender, race, and age or in preoperative and one year postoperative HbA1c when stratifying by indication for liver transplant, gender, and race. Patients < 50 years had a significantly greater one year postoperative HbA1c compared to their preoperative HbA1c (5.10 vs 6.09, p =0.048). There was no significant difference in preoperative and one year postoperative HbA1c in patients ≥50 years. (Table) Conclusion: Significant elevations in HbA1c post-transplant may predispose patients to post-transplant diabetes, which is associated with transplant dysfunction and mortality, and may cause post-transplant metabolic syndrome, which increases the risk of and complications from cardiovascular events. Our data showed that patients under the age of 50 need careful monitoring to minimize modifiable metabolic abnormalities. Determining high-risk populations for post-transplant complications is crucial to reduce long-term post-transplant morbidity and mortality. Further research is needed to elucidate additional risk factors for post-transplant complications. Table 1. - Metabolic Changes After 1 Year Liver Transplant Total Patients (%) Mean BMI (95% CI) At Transplant At 1 year after Transplant p-value Overall 90 (100) 31.01 (29.90-32.13) 30.88 (29.59-32.17) 0.16 Indication for Transplant NASH/NAFLD 27 (30.7) 33.08 (31.12-35.03) 32.30 (31.55-33.06) 0.21 Alcohol 11 (12.5) 26.19 (23.22-29.16) 25.96 (24.12-27.80) 0.45 HCV 9 (10.2) 30.81 (27.35-34.27) 31.23 (28.83-33.62) 0.36 HBV 2 (2.3) 37.2 (49.12-25.28) 34.40 (57.76-11.04) 0.13 PSC 1 (1.1) 25.8 (n/a) 26.3 (n/a) n/a HCC 3 (3.4) 29.00 (25.88-32.12) 28.53 (24.20-32.86) 0.30 Cirrhosis NOS/Cryptogenic 13 (14.8) 28.57 (25.65-31.49) 29.54 (27.89-31.19) 0.21 HCV + HCC 18 (20.5) 32.09 (29.65-34.53) 31.63 (30.47-32.79) 0.19 NASH + HCC 2 (2.3) 31.40 (19.48-43.32) 33.72 (10.36-57.08) 0.13 Alcohol + HCC 2 (2.3) 30.00 (20.45-39.55) 28.51 (9.80-47.23) 0.37 HCC=hepatocellular carcinoma, NASH= nonalcoholic steatohepatitis, HBV= Hepatitis B, HCV= Hepatitis C, PSC=primary sclerosing cholangitis.

Growing challenge of post-liver transplantation non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide, with an estimated prevalence of 25%. Post-liver transplantation (LT) recurrent or de novo hepatic steatosis is a common complication in recipients, irrespective of transplantation indication. Risk factors for graft steatosis mainly include obesity, immunosuppression, donor steatosis, and genetic factors. Liver transplant recipients are at high risk of developing insulin resistance, new-onset diabetes, and post-transplantation metabolic syndrome that is highly associated with immunosuppressive treatment. Post-LT NAFLD is often underdiagnosed due to the poor sensitivity of most routine imaging methods. The gold standard for the diagnosis of hepatic steatosis is liver biopsy, which is, however, limited to more complex cases due to its invasive nature. There is no approved pharmacotherapy in NAFLD. Lifestyle modification remains the cornerstone in NAFLD treatment. Other treatment strategies in post-LT NAFLD include lifestyle modifications, pharmacotherapy, bariatric surgery, and tailored immunosuppression. However, these approaches originate from recommendations in the general population, as there is scarce data regarding the safety and efficacy of current management strategies for NAFLD in liver transplant patients. Future prospective studies are required to achieve tailored treatment for these patients.

Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial.

BackgroundPosttransplant metabolic syndrome (PTMS) is a common contributor to morbidity and mortality among solid organ transplant recipients in the late posttransplant period (≥1 year). Patients diagnosed with PTMS are at a higher risk of cardiovascular disease and frequently experience decreased physical function and health-related quality of life (HRQL). Studies in the early posttransplant period (<1 year) have shown the benefits of facility-based exercise training on physical function and HRQL, but have not evaluated the effects on metabolic risk factors. It remains unclear whether home-based exercise programs are feasible and can be delivered at a sufficient exercise dose to have effects on PTMS. This protocol outlines the methodology of a randomized controlled trial of a partly supervised home-based exercise program in lung transplant (LTx) and orthotopic liver transplant (OLT) recipients.ObjectiveThis study aims to evaluate the feasibility (ie, recruitment rate, program adherence, attrition, safety, and participant satisfaction) of a 12-week individualized, home-based aerobic and resistance training program in LTx and OLT recipients initiated 12 to 18 months after transplantation, and to assess estimates of intervention efficacy on metabolic risk factors, exercise self-efficacy, and HRQL.MethodsIn total, 20 LTx and 20 OLT recipients with ≥2 cardiometabolic risk factors at 12 to 18 months after transplantation will be randomized to an intervention (home-based exercise training) or control group. The intervention group will receive an individualized exercise prescription comprising aerobic and resistance training, 3 to 5 times a week for 12 weeks. Participants will meet on a weekly basis (via videoconference) with a qualified exercise professional who will supervise exercise progression, provide support, and support exercise self-efficacy. Participants in both study groups will receive a counseling session on healthy eating with a dietitian at the beginning of the intervention. For the primary aim, feasibility will be assessed through recruitment rate, program adherence, satisfaction, attrition, and safety parameters. Secondary outcomes will be measured at baseline and 12 weeks, including assessments of metabolic risk factors (ie, insulin resistance, abdominal obesity, blood pressure, and cholesterol), HRQL, and exercise self-efficacy. Descriptive statistics will be used to summarize program feasibility and effect estimates (means and 95% CIs) for sample size calculations in future trials.ResultsEnrollment started in July 2021. It is estimated that the study period will be 18 months, with data collection to be completed by December 2022.ConclusionsA partly supervised home-based, individually tailored exercise program that promotes aerobic and resistance training and exercise self-efficacy may be an important intervention for improving the metabolic profile of LTx and OLT recipients with cardiometabolic risk factors. Thus, characterizing the feasibility and effect estimates of home-based exercise constitutes the first step in developing future clinical trials designed to reduce the high morbidity associated with PTMS.Trial RegistrationClinicalTrials.gov NCT04965142; https://clinicaltrials.gov/ct2/show/NCT04965142International Registered Report Identifier (IRRID)DERR1-10.2196/35700

A prospective natural history study of coronary atherosclerosis following liver transplantation

Background & aimsCardiovascular disease remains a leading cause of mortality following liver transplantation (LT). Whether it may be partially attributable to accelerated development of subclinical coronary artery disease is unclear. We sought to assess the longitudinal effect of LT on coronary plaque burden. MethodsA prospective observational study was conducted in 30 asymptomatic patients who underwent computed tomographic coronary angiography (CTCA) pre- and a median 4-years following LT. Serial changes were quantified using coronary artery calcium score (CACS) and semi-quantitative CTCA scores, in a blinded fashion. High-risk plaque (HRP) characteristics were also assessed. Plaque progression was defined using prognostically significant cut-offs. ResultsIn the study population (age 59.8 ± 8 years, 80% male), 93 of 459 coronary segments had plaque at baseline. On follow-up CTCA, 68 (+73.1%) new lesions appeared in segments without plaque initially. Nineteen (63.3%) patients demonstrated a clinically significant rise in plaque burden on CACS and semi-quantitative indices on CTCA (all p<0.001). CAD-RADS score rose to ≥4 (≥70% stenosis) in 9 (30%) patients, necessitating ischemia-guided revascularization in 3 (10%) patients. While the absence of coronary calcification or plaque pre-LT was protective, presence of HRP and development of post-transplant metabolic syndrome were both strong independent predictors of atherosclerosis progression. ConclusionsOur findings suggest that LT is associated with early progression of coronary atherosclerosis. Accelerated progression was noted particularly in those with HRP and post-transplant metabolic syndrome. Understanding the mechanisms of this novel observation and the potential role of preventive cardiovascular therapies in this population merit further study.

Metabolic syndrome following liver transplantation in nonalcoholic steatohepatitis.

Metabolic syndrome is a major clinical disorder involving metabolic dysregulation characterized clinically with features of central obesity, insulin resistance (IR), type 2 diabetes, hypertension, and dyslipidemia. Metabolic syndrome is strongly associated with the rising prevalence nonalcoholic steatohepatitis, a leading indication for orthotopic liver transplantation in the Western world. The presence or recurrence of metabolic syndrome following liver transplantation can contribute to the development and recurrence of nonalcoholic fatty liver disease (NAFLD) in the liver allograft. In this review, we discuss the endogenous and exogenous drivers of post-transplant metabolic syndrome, role of chronic immunosuppression, and the prevalence and clinical significant of post-transplant metabolic syndrome on nonalcoholic steatohepatitis.

Is post-transplant metabolic syndrome associated with pre-liver transplant visceral adipose tissue area?

Post-liver transplant metabolic syndrome (PTMS) is a significant independent risk factor for the development of cardiovascular disease. The impact of pre-transplant body composition on the risk of developing PTMS has not been evaluated and was the aim of this study. Seventy-five consecutive adult patients listed for liver transplant were included in the analysis. Anthropometric and metabolic data were collected pre-transplant and at three months post-transplant. Metabolic syndrome was defined in accordance with international guidelines. Skeletal muscle area (SMA), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were derived from computed tomography. Ten patients (13%) developed de novo PTMS by 3 months post-transplant. Patients who developed PTMS had higher pre-transplant body mass index (BMI) (P=0.01), VAT (P=0.001) and SAT (P=0.008). Univariate logistic regression found that BMI, VAT and SAT were significant predictors for the development of PTMS. After stepwise multivariate analysis, only VAT remained a significant predictor (OR 1.02, 95%CI 1.01-1.04; P=0.04). Higher pre-transplant VAT is independently associated with the development of metabolic syndrome three months post-transplant. Body composition analysis using cross-sectional imaging prior to liver transplant can assist with identifying patients at greatest risk for developing PTMS.

Successful Outcome of Bariatric Surgery in Living Donor Liver Transplant Recipients With Multidisciplinary Approach: A Preliminary Experience

Liver transplant recipients may develop weight gain, metabolic syndrome, and subsequent nonalcoholic steatohepatitis of the transplanted liver which impairs graft function. Bariatric surgery is an effective modality for management of morbid obesity and metabolic syndrome. Our aim is to review the role of bariatric surgery in such high-risk posttransplant patients not responding to medical management and highlight the important considerations. We review the management of two cases with posttransplant metabolic syndrome not responding to medical management and discuss the literature available on bariatric surgery in organ transplant patients. The first patient was a 51-year-old man who underwent living donor liver transplantation 3 years prior, and follow-up ultrasound and fibroscan was suggestive of steatohepatitis of the graft. After liver transplantation, he had gained 30Kg weightand was on oral hypoglycemic agents with HbA1c of 8%. The second patient was a 65-year-old man, who gained 30Kg weight with risk of graft impairment 4 years after of combined liver and kidney transplant. Both patients were evaluated thoroughly preoperatively for risk stratification including an upper gastro-intestinal (GI) endoscopy. The immunosuppression was reduced and monitored closely perioperatively. Both patients underwent laparoscopic sleeve gastrectomy (LSG) and were discharged on postoperative day 3. The first patient was evaluated a year after surgery with body mass index (BMI) reduction from 42 to 34 and second at 2 months with BMI reduction from 38 to 33; both patients were free of diabetes and had stable graft functions. Bariatric surgery in liver transplant recipients has significant challenges with higher complication rates as patients are on immunosuppression which often impairs wound healing. LSG is safe and effective in such patients which often requires good coordination between the bariatric team and liver transplant team.

Weight Gain After Simultaneous Kidney and Pancreas Transplantation.

Excessive weight (EW) gain is common after solid organ transplantation, but there is little information concerning obesity after pancreas transplantation. The study goal was to characterize EW gain after kidney-pancreas (KP) transplantation. This was a retrospective single-center review of 100 KP recipients transplanted between September 2007 and June 2015. The median percent weight gain for all recipients at 1 year posttransplant was 10% (interquartile range, 2.7%-19.3%) of baseline weight. EW gain, defined as greater than or equal to a 19% 1-year increase in weight, included all recipients (n = 26) above the upper limit of interquartile range for weight gain at 1 year. In multivariate analysis, recipient age <40 years, the use of tacrolimus/mammalian target of rapamycin immunosuppression, and an acute rejection event were independent risk factors for EW gain. At a mean follow-up of 43±23 months, there was no difference in patient or graft survival between the EW and non-EW cohorts. Although mean hemoglobin A1c levels between groups were equivalent, the EW versus non-EW cohort displayed a significant increase in mean insulin levels and a trend towards higher C-peptide levels. Criteria for posttransplant metabolic syndrome was met in 34.6% of EW versus 17.6% of non-EW cohorts (P = 0.07). At intermediate-term follow-up, EW gain after KP transplantation was not associated with an increased risk of death or graft loss, although there was a trend toward a greater risk of posttransplant metabolic syndrome. There may be a metabolic consequence of successful pancreas transplantation that results in EW gain in a proportion of recipients, leading to an increased risk of long-term cardiovascular complications.

Incidence of New-Onset Diabetes and PostTransplant Metabolic Syndrome after Liver Transplantation - A Prospective Study from South India.

Background and Aims:Liver transplantation has become an effective therapy for patients with end-stage liver disease. The risk of new-onset diabetes after transplantation (NODAT) and posttransplant metabolic syndrome (PTMS) is high among patients after liver transplantation. These are thought to be associated with increased risks of graft rejection, infection, cardiovascular disease, and death. Our study aimed to document the incidence of NODAT and PTMS and analyze pre and posttransplant predictive factors for their development in patients undergoing a liver transplant.Methods:This was a prospective comparative study on 51 patients who underwent live donor liver transplantation. They were evaluated at baseline, 3 and 6 months after transplantation with fasting glucose, lipids, serum insulin levels, C-peptide, and HbA1C. They were followed up at 5 years to document any cardiovascular events or rejection.Results:The incidence of preoperative diabetes mellitus (DM) in the study group was 25/51 (49%). The incidence of NODAT was 38.5% (10/26 patients) and PTMS 29% (10/35), respectively. Age (47.7 ± 5.4 vs 41.5 ± 12.7 years), HOMA2 - IR (2.3 ± 1.8 vs 2.1 ± 1.6), serum insulin (16.1 ± 12.0 vs 17.9 ± 14.5), and C-peptide (4.6 ± 0.5 vs 4.8 ± 0.7) were similar at baseline in the NODAT group compared to those who did not develop it. Mean tacrolimus levels were higher in PTMS group (6.8 ± 2.9 vs 5.0. ± 2.0 P value = 0.042). By the end of 5 years, 7 patients expired; 6 due to rejection and one due to cardiovascular disease. Moreover, 2 of these patients had preexisting DM and 2 had NODAT.Conclusions:None of the baseline metabolic factors in patients undergoing liver transplant were predictive of the development of NODAT or PTMS. Mean tacrolimus levels were significantly higher in the PTMS group. A 5-year follow-up showed no excess risk of cardiovascular events or rejection in those with preexisting DM or in those who developed NODAT.

Metabolic Syndrome Post Allogeneic STEM CELL Transplantation in Adult Patients Is NOT an Uncommon Complication. a Single Center Experience

Background: The significant advances which have been achieved in the field of allogeneic transplantation (alloHCT) have resulted in better post-transplant outcome and prolonged survival. Therefore, complications other than the Graft vs. Host disease (GvHD) or disease recurrence have become increasingly important. The post-transplant metabolic syndrome (PT-MS), caused by several factors (i.e. immunosuppressive agents, chemo-radiotherapy, anti-viral, and biologic therapies) is a well known post-transplant complication in pediatric allografted long-term survivors however, only a few studies have evaluated the prevalence of the PT-MS in adults. In this retrospective study, we sought to evaluate the incidence, risk factors and impact of the PT-MS on alloSCT outcome. Methods: From 1/2011 to 12/2018, 54 patients (34 males and 20 females) with adequate clinical and laboratory data and a minimum follow-up of 6 months were included in the study. Median age was 35.6 years (range, 16-67) and following a myeloablative (n=34) or reduced intensity (n=20) regimen patients received either a mobilized peripheral blood stem cell (n=45) or marrow (n=9) graft originating from full-matched siblings (n=46) or haploidentical (n=8) donors. Calcineurin inhibitors plus either short-term Methotrexate or Mycophenolate Mofetil were given as GvHD prophylaxis. Diagnosis of PT-MS was based on NCEP-ATPIII criteria; for patients with unknown data for abdominal circumference, a modified criterion of body mass index (BMI) ≥25kg/m2 was utilized instead. The independent t-test, logistic regression analysis and log-rank tests were used for statistical analysis. Results: Twenty-four (44%) patients (14 males, 10 females) fulfilled the criteria for PT-MS. Twenty had been diagnosed after the 1st trimester, 3 patients after the 2nd and in addition 1 after the 3rd trimester post alloSCT. Twenty out of 24 (83%) patients had elevated glucose, 19/24 (80%) had BMI&gt;25kg/m2, 18/24 (75%) elevated triglycerides levels, 14/24 (60%) low HDL levels and 13/24 (55%) hypertension. Six (25%) had a known history of MS before alloSCT (10 patients had no available data to assess for MS diagnosis prior to alloSCT). Interestingly, in 8/24 (33%) patients who had PT-MS diagnosed early, either in the 1st or 2nd trimester, the syndrome was completely reversible beyond the 6-month post alloSCT follow-up period. In the aforementioned statistical models, patients' gender, age, BMI, type of conditioning regimen and GvHD co-existence were evaluated as potential predisposing factors for the PT-MS. In univariate and multivariate analysis only BMI&gt;25kg/m2 and age&gt;35 years were detected as significant risk factors (p&lt; 0.01) for development of PT-MS. The PT-MS did not adversely impact survival or the NRM incidence post alloSCT. Conclusions: In our study, in agreement with other publications, we demonstrate that the PT-MS is not an uncommon complication in the early post-transplant period however, for approximately 1/3 of patients the syndrome was reversible. For patients with high risk features (BMI&gt;25kg/m2, age&gt; 35 years, known history of diabetes-mellitus, dyslipidemia, hypertension) apart of close monitoring, specific diet and encouragement for exercise might help reduce the incidence and severity of PT-MS. Nevertheless, prospective and well design trials are warranted to determine the incidence, severity and impact of PT-MS on alloSCT outcome for adult patients. Disclosures No relevant conflicts of interest to declare.

Su1476 – Evaluating Quality of Post-Transplant Metabolic Syndrome Management in Liver Transplant Patients

Su1476 – Evaluating Quality of Post-Transplant Metabolic Syndrome Management in Liver Transplant Patients

The ILTS Consensus Conference on NAFLD/NASH and Liver Transplantation: Setting the Stage.

The ILTS Consensus Conference on NAFLD/NASH and Liver Transplantation: Setting the Stage.

Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death.

AIMTo describe the prevalence of posttransplant metabolic syndrome (PTMS) after donation after cardiac death (DCD) liver transplantation (LT) and the pre- and postoperative risk factors.METHODSOne hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre- and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-III criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.RESULTSThe prevalence of PTMS after DCD donor orthotopic LT was 20/147 (13.6%). Recipient’s body mass index (P = 0.024), warm ischemia time (WIT) (P = 0.045), and posttransplant hyperuricemia (P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients (P < 0.001). After the 1st mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.CONCLUSIONPTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

Clinical Food Addiction Is Not Associated with Development of Metabolic Complications in Liver Transplant Recipients.

Background and Aims: Given the increased risk of post-transplant metabolic syndrome (PTMS; defined by hypertension, diabetes mellitus and hyperlipidemia), we aimed to identify the potential role of food addiction in the development of metabolic complications in the post-liver transplant population.Methods: Inclusion criteria included adult liver transplant recipients followed at our institution between June 2016 and November 2016. Participants were administered a demographic survey as well as the Yale Food Assessment Scale 2.0, a 35-item questionnaire used to assess frequency of food addiction in accordance with the DSM-V guidelines of substance use disorders. Demographic and clinical data were collected.Results: Our study included 236 liver transplant recipients (139 males, 97 females). The median (interquartile range [IQR]) BMI of participants was 26.8 kg/m2 (24.2, 30.4), and median (IQR) time since transplantation was 50.9 months (19.6, 119.8). The prevalence rates of hypertension, hypercholesterolemia and diabetes mellitus were 54.7%, 25.0% and 27.1%, respectively. Twelve participants (5.1%) were found to have a diagnosis of food addiction. A diagnosis of food misuse was made in 94 (39.8%) of the transplant recipients.Conclusions: Our findings are consistent with prior data that indicate high prevalence of metabolic complications among liver transplant recipients. Food addiction was not predictive of metabolic complications within this population. Nevertheless, we found that this population was at high risk of demonstrating symptoms of food misuse, and they were not likely to appreciate the risks of pathologic patterns of eating. Given the increasing risk of cardiovascular morbidity and mortality in this population, efforts should be made to identify risk factors for the development of PTMS.

Everolimus Is Associated With Less Weight Gain Than Tacrolimus 2 Years After Liver Transplantation: Results of a Randomized Multicenter Study.

BackgroundWeight gain early after transplant is a risk factor for posttransplant metabolic syndrome (PTMS), cardiovascular events, and renal insufficiency. The impact of mammalian target of rapamycin inhibition on posttransplant weight gain and the development of PTMS components postliver transplantation were examined in a randomized, controlled study.MethodsAfter a run-in period, patients (N = 719) were randomized at 30 ± 5 days posttransplant in a 1:1:1 ratio to 3 treatment groups: (i) everolimus (EVR) + reduced tacrolimus (TAC) (n = 245); (ii) TAC control (n = 243) or (iii) TAC elimination (n = 231). In this post hoc analysis, weight change at 12 and 24 months was compared between groups. Vital signs, lipids, and laboratory parameters at 12 and 24 months and rates of PTMS were assessed.ResultsMean increase in weight from baseline was higher at month 12 in the TAC control arm (8.15 ± 9.27 kg) than in the EVR + reduced TAC (5.88 ± 12.60 kg, P = 0.056) and the TAC elimination arms (4.76 ± 9.94 kg, P = 0.007). At month 24, the TAC control arm displayed a significantly greater weight increase (9.54 ± 10.21 kg) than either the EVR + reduced TAC (6.69 ± 8.37 kg, P = 0.011) or the TAC elimination groups (6.01 ± 9.98 kg, P = 0.024). Rates of PTMS were similar for the EVR + reduced TAC (71.8%), TAC elimination (70.3%) and TAC control (67.4%) arms (P = NS).ConclusionsEVR with reduced-exposure TAC attenuated weight gain at 1 and 2 years posttransplant compared with a standard TAC immunosuppression regimen. Rates of PTMS were comparable between EVR-containing and TAC control regimens.