Ethnicity predicts metabolic syndrome after liver transplant
Tóm tắt
Post-transplant metabolic syndrome (PTMS) is associated with important causes of morbidity and mortality in solid organ transplant recipients. Our aim was to investigate predictors of PTMS in liver transplant (LT) recipients. We randomly selected 343 adults (>18 years of age) from a large cohort of 1,262 ethnically diverse patients who received LTs during 2000–2010. Of 343 patients included, 68.2 % were male, with a mean age of 54 ± 10 years, 87 % White, and 31 % Hispanic. Prior to LTs, 6.2 % were on lipid-lowering agents and 24.5 % had BMI ≥ 30 (mean 26.9 ± 5 kg/m2). More Hispanics had diabetes before LTs compared to non-Hispanics (p = 0.037). Among those with follow-up of >6 months (n = 304) after LTs, the proportion of patients with diabetes and hypertension increased from 21.9 to 27 % (p < 0.0001), and from 11.5 to 51.6 % (p < 0.0001), respectively. Cholesterol levels increased from 150 ± 115 to 167 ± 70 (p < 0.0001). BMI remained unchanged. PTMS developed in 41 (13.5 %) and cardiovascular events in 31 (10.2 %) patients. Hispanics had higher risk of developing PTMS compared to non-Hispanics (OR 2.30, 95 % CI 1.18–4.49). Survival was not affected by PTMS (p = 0.3), ethnicity (p = 0.52), or nonalcoholic steatohepatitis as the etiology of liver disease (p = 0.50). More Hispanics had diabetes before LTs (29 to 18 %, p < 0.05) and were more prone to developing PTMS after LTs compared to non-Hispanics.
Tài liệu tham khảo
Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366(9491):1059–1062
Laryea M, Watt KD, Molinari M, et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl. 2007;13(8):1109–1114
Bianchi G, Marchesini G, Marzocchi R, Pinna AD, Zoli M. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl. 2008;14(11):1648–1654
Laish I, Braun M, Mor E, et al. Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events. Liver Transpl. 2011;17(1):15–22
Gelson W, Hoare M, Dawwas MF, et al. The pattern of late mortality in liver transplant recipients in the United Kingdom. Transplantation. 2011;91(11):1204–1240
Moore DE, Feurer ID, Rodgers S, et al. Is there racial disparity in outcomes after solid organ transplantation? Am J Surg. 2004;188(5):571–574
Neal DA, Tom BD, Luan J, et al. Is there disparity between risk and incidence of cardiovascular disease after liver transplant? Transplantation. 2004;77(1):93–99
Marchetti P, Navalesi R. The metabolic effects of cyclosporin and tacrolimus. J Endocrinol Invest. 2000;23(7):482–490
Ruiz-Rebollo ML, Sanchez-Antolin G, Garcia-Pajares F. Risk of development of the metabolic syndrome after orthotopic liver transplantation. Transplant Proc. 2010;42(2):663–665
Hanouneh IA, Feldstein AE, McCullough AJ, et al. The significance of metabolic syndrome in the setting of recurrent hepatitis C after liver transplantation. Liver Transpl. 2008;14(9):1287–1293
Ferguson PJ, Lokuta MA, El-Shanti HI, et al. Neutrophil dysfunction in a family with a SAPHO syndrome-like phenotype. Arthritis Rheum. 2008;58(10):3264–3269
Gustafsson PE, Persson M, Hammarstrom A. Life course origins of the metabolic syndrome in middle-aged women and men: the role of socioeconomic status and metabolic risk factors in adolescence and early adulthood. Ann Epidemiol. 2011;21(2):103–110
Salsberry PJ, Corwin E, Reagan PB. A complex web of risks for metabolic syndrome: race/ethnicity, economics, and gender. Am J Prev Med. 2007;33(2):114–120
NCEP. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–2497
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–2752
Bhagat V, Mindikoglu AL, Nudo CG. Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease. Liver Transpl. 2009;15(12):1814–1820
Review of the racial and ethnic standards to the OMB concerning changes [database on the Internet] 1997. The Hispanic population:2010. Accessed 9 July 2012 at http://www.census.gov.prod/cen2010/briefs/c2010br-04.pdf
Mejia A, Halff GA, Esterl R, et al. Outcome of liver transplantation in Hispanics versus non-Hispanics: is there a difference? Transplant Proc. 2002;34(4):1236–1238
Yala SM, Fleck EM, Sciacca R, et al. Metabolic syndrome and the burden of cardiovascular disease in Caribbean Hispanic women living in northern Manhattan: a red flag for education. Metab Syndr Relat Disord. 2009;7(4):315–322
Census rate and Hispanic. [database on the Internet] 2010. Miami Dade County Quick Facts from the US Census Bureau. Accessed 9 July 2012 at http://quickfacts.census.gov/qfd/states/12/12086.html
Carrion AF, Ghanta R, Carrasquillo O, Martin P. Chronic liver disease in the Hispanic population of the United States. Clin Gastroenterol Hepatol. 2011;9(10):834–841. quiz e109–e110
Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes Care. 2004;27(10):2444–2449
Bureau USC (2010) Income, poverty and healthy insurance coverage in the United States: 2009, Current Population Report, pp. P60–P238
Yoo HY, Thuluvath PJ. Outcome of liver transplantation in adult recipients: influence of neighborhood income, education, and insurance. Liver Transpl. 2004;10(2):235–243
Nair S, Eustace J, Thuluvath PJ. Effect of race on outcome of orthotopic liver transplantation: a cohort study. Lancet. 2002;359(9303):287–293
Romeo S, Kozlitina J, Xing C, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40(12):1461–1465
Davis JN, Le KA, Walker RW, et al. Increased hepatic fat in overweight Hispanic youth influenced by interaction between genetic variation in PNPLA3 and high dietary carbohydrate and sugar consumption. Am J Clin Nutr. 2010;92(6):1522–1527
Wagenknecht LE, Palmer ND, Bowden DW, et al. Association of PNPLA3 with non-alcoholic fatty liver disease in a minority cohort: the Insulin Resistance Atherosclerosis Family Study. Liver Int. 2011;31(3):412–416
Hakeam HA, Al-Jedai AH, Raza SM, Hamawi K. Sirolimus induced dyslipidemia in tacrolimus based vs. tacrolimus free immunosuppressive regimens in renal transplant recipients. Ann Transplant. 2008;13(2):46–53
Pescovitz MD, Nezakatgoo N, Lorber MI, et al. Prospective observational study of sirolimus as primary immunosuppression after renal transplantation. Transplantation. 2009;88(8):1010–1018
Delgado-Borrego A, Casson D, Schoenfeld D, et al. Hepatitis C virus is independently associated with increased insulin resistance after liver transplantation. Transplantation. 2004;77(5):703–710
Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2010;34(1):216–219
Stegall MD, Everson G, Schroter G, et al. Metabolic complications after liver transplantation. Diabetes, hypercholesterolemia, hypertension, and obesity. Transplantation. 1995;60(9):1057–1060
Baid S, Cosimi AB, Farrell ML, et al. Posttransplant diabetes mellitus in liver transplant recipients: risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation. 2001;72(6):1066–1072
Contos MJ, Cales W, Sterling RK, et al. Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transpl. 2001;7(4):363–373
Everhart JE, Lombardero M, Lake JR, et al. Weight change and obesity after liver transplantation: incidence and risk factors. Liver Transpl Surg. 1998;4(4):285–296
Gisbert C, Prieto M, Berenguer M, et al. Hyperlipidemia in liver transplant recipients: prevalence and risk factors. Liver Transpl Surg. 1997;3(4):416–422
Satapathy SK, Charlton MR. Posttransplant metabolic syndrome: new evidence of an epidemic and recommendations for management. Liver Transpl. 2011;17(1):1–6
Gami AS, Witt BJ, Howard DE. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403–414
Watt KD, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant. 2010;10(6):1420–1427
Reid AE. The impact of race on liver transplant outcomes in the MELD era: still more questions than answers. Am J Gastroenterol. 2008;103(4):911–913
Angulo P. Diagnosing steatohepatitis and predicting liver-related mortality in patients with NAFLD: two distinct concepts. Hepatology. 2011;53(6):1792–1794