Introduction: The proportion of patients with metabolic syndrome (MetS) after orthotopic
liver transplantation (OLT) is substantial higher compared to the general population. MetS
consists of a cluster of obesity, raised glucose, raised triglycerides, reduced High-Density
Lipoproteins and raised blood pressure, which is associated with an increased risk of
cardiovascular disease, diabetes mellitus and liver steatosis. The difference in prevalence might
among other things be attributed to the use of immunosuppressants.
Objectives: The main goal was to investigate whether there is a difference in occurrence of
MetS after OLT between patients treated with a calcineurin inhibitor (CNi) and patients treated
with an mTOR inhibitor (mTORi), two common used immunosuppressive drugs. In addition,
the responsible components for the development and disappearance of MetS were studied.
Methods: In this retrospective study, patients who underwent an OLT between 2006 and 2012
at the Universitätsklinikum Münster were observed. The MetS status (no MetS, new developed
MetS, persistent MetS and disappeared MetS) was determined at baseline (T0), one (T1), three
(T3), five (T5) and eight (T8) years after OLT. In addition, the responsible components for the
development and disappearance of MetS were determined. Patients who were continuously
treated with a CNi were compared with patients who were switched from a CNi to an mTORi.
At baseline, all patients were evaluated in the continuous CNi group.
Results: In total, 134 patients were included in this study. The incidence of MetS in the
continuous CNi group was 18.8%, 12.8%, 14.3% and 50.0%, while the incidence in the mTORi
switchers group was 47.8%, 23.8%, 23.1% and 60.0% at T1, T3, T5 and T8, respectively. In
the continuous CNi group, MetS disappeared in 41.7%, 46.7%, 28.6% and 0%, while it
disappeared in the mTORi switchers group in 42.9%, 12.5%, 12.5% and 25.0% of the patients
at T1, T3, T5 and T8, respectively. Within both groups, the component raised triglycerides
arose most often in patients who developed MetS. However, this proportion was substantially
higher in the mTORi switchers group. Within both groups the component reduced HDL
disappeared most often.
Conclusion: Liver transplant recipients who are switched to an mTORi seem to develop more
often MetS than patients who are continuously treated with a CNi. Furthermore, patients who
are continuously treated with a CNi seem to have a greater chance to recover from MetS. In
most cases, development of MetS seem to be caused by increased triglyceride levels, especially
in the mTORi switchers group. Independent of the immunosuppressant group, disappearance
of MetS seems to be most often the consequence of normalization of the HDL concentration.
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