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World J Gastroenterol. Jul 28, 2016; 22(28): 6416-6423
Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6416
Metabolic complications in liver transplant recipients
Miguel Jiménez-Pérez, Rocío González-Grande, Edith Omonte Guzmán, Víctor Amo Trillo, Juan Miguel Rodrigo López
Miguel Jiménez-Pérez, Rocío González-Grande, Edith Omonte Guzmán, Víctor Amo Trillo, Juan Miguel Rodrigo López, UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Universitario Regional de Málaga, 29010 Málaga, Spain
Author contributions: Jiménez-Pérez M, González-Grande R, Omonte Guzmán E, Amo Trillo V and Rodrigo López JM contributed equally to this work.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miguel Jiménez-Pérez, MD, UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Universitario Regional de Málaga, Avenida Carlos Haya, 29010 Malaga, Spain. mjimenezp@commalaga.com
Telephone: +34-61095935 Fax: +34-951291941
Received: April 12, 2016
Peer-review started: April 14, 2016
First decision: May 12, 2016
Revised: May 25, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 28, 2016
Processing time: 101 Days and 9.7 Hours
Abstract

The metabolic syndrome (MS), which includes obesity, dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease (CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease (NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.

Keywords: Metabolic syndrome; Liver transplantation; Immunosuppressions; Risk factors; Non-alcoholic fatty liver disease

Core tip: The metabolic syndrome is a very frequent complication after liver transplantation; indeed, over half transplant patients will eventually develop it. It is also a risk factor for the development of cardiovascular disease, one of the main causes of long-term death after transplantation. The identification and early treatment of such factors as hypertension, dyslipidaemia, obesity and diabetes is crucial to achieve a positive impact on long-term survival of liver transplant patients.