Background and Aims: Due to the improved survival after liver transplantation (LT), greater attention has been reserved to diseases occurring within the long term follow-up, such as Post- Transplantation Metabolic Syndrome (PTMS). Several predictors for PTMS have been identified: higher age at transplant, male gender, pre-LT metabolic derangements, the etiology of hepatopathy and immunosuppression. This syndrome contributes to increase the cardiovascular risk in transplanted patients. Aim of the study was 1. to evaluate the prevalence and the incidence of the Post- Transplant Metabolic Syndrome (PTMS); 2. To evaluate risk factors and predictors for its development; 3. To verify its influence on patients' cardiovascular risk. Methods: We enrolled 156 patients (mean age 58±9 years, 76% male) who underwent LT during the last twenty years. Mean follow-up was 67±50 months (range 6-114 months). Personal and clinical data were collected retrospectively for each patients; PTMS was diagnosed according to modified NCEP ATPIII criteria. Cardiovascular risk was calculated as suggested in www.iss.cuore.it. Results: PTMS was present in 28% of the patients. All metabolic traits increased from pre-LT to post-LT period (arterial hypertension from 13 to 52%, diabetes mellitus from 17 to 30%, dyslipidemia from 8 to 58%); the prevalence of overweight/obesity did not change significantly. Diabetes mellitus represents the disturbance more contributing to diagnosis of PTMS (95%). Two independent predictive factors were identified, i.e. pre-OLT overweight/obesity ([OR] = 8.2) and diabetes mellitus ([OR] = 4.3). The prevalence of PTMS was higher in patients on Cyclosporine than in those on Tacrolimus (21% Vs 38%, p = 0.00). Cyclosporine showed a significant association with all metabolic derangements, except diabetes mellitus, for which a difference between Cyclosporine and Tacrolimus was not found. The majority of patients had a diagnosis of PTMS within the first two years after LT. Twenty-one percent of patients with PTMS showed an high (≥20%) cardiovascular risk (6% in those without PTMS). Cardiovascular events occurred in 6 patients (4% of total), the majority of them were males and belonged to the group of patients with PTMS. Conclusions: A close follow-up and “tailoring” of immunosuppressive therapy is mandatory to prevent the development of PTMS mainly in patients overweight and diabetic before transplantation.
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Iadevaia, M. D., Giusto, M., Giannelli, V., Lai, Q., Rossi, M., Berloco, P., … Merli, M. (2012). 164 POST-TRANSPLANTATION METABOLIC SYNDROME: IS IT ONLY A THERAPEUTIC CONCERN? Journal of Hepatology, 56, S72. https://doi.org/10.1016/s0168-8278(12)60177-9