Predicting dyslipidemia after liver transplantation: A significant role of recipient metabolic inflammation profile

Table 1 Comparison of perioperative findings between post-transplant dyslipidemia and non-post-transplant dyslipidemia groups

	PTDL (n = 278)	Non-PTDL (n = 118)	P value
Recipient factors
Age (yr)	48.2 ± 9.6	49.1 ± 9.1	0.411
Male, n (%)	237 (85.3)	102 (86.4)	0.758
BMI (kg/m2)	23.2 ± 3.2	22.3 ± 2.9	0.012
MELD score	20.9 ± 10.9	20.6 ± 11.7	0.777
Laboratory value
Creatinine (μmol/L)	65.0 (53.0-83.8)	66.0 (55.0-78.0)	0.925
Albumin (g/L)	34.7 (31.0-38.2)	35.5 (32.2-39.6)	0.218
TB (μmol/L)	63.5 (28.0-335.5)	58.5 (22.3-205.8)	0.066
INR	1.5 (1.3-1.9)	1.4 (1.2-1.7)	0.087
AST (U/L)	66.0 (37.0-128.8)	71.5 (38.3-125.5)	0.694
ALT (U/L)	43 (24.0-93.3)	40.5 (26.0-125.0)	0.621
TC (mg/dL)	100.5 (65.7-139.2)	104.4 (73.5-135.3)	0.947
TG (mg/dL)	88.6 (62.0-115.1)	70.9 (53.1-97.4)	0.017
HDLC (mg/dL)	23.2 (11.6-34.8)	27.1 (15.5-42.5)	0.024
LDLC (mg/dL)	47.6 (27.1-73.5)	46.4 (30.9-69.6)	0.676
VLDLC (mg/dL)	23.2 (15.5-38.7)	19.3 (11.6-30.9)	0.052
FBG (mmol/L)	6.3 (5.3-8.0)	6.0 (5.3-7.4)	0.328
Cirrhosis, n (%)	206 (74.1)	94 (79.7)	0.238
HCC, n (%)	108 (38.8)	61 (51.7)	0.018
HBV status, n (%)
HBsAg positive	215 (77.3)	102 (86.4)	0.038
HBeAg positive	81 (29.1)	27 (22.9)	0.201
HBV DNA > 1000 copies/mL	39 (14.0)	18 (15.3)	0.751
Pre-LT AVT	108 (38.8)	52 (44.1)	0.333
Comorbidities, n (%)
Hepatic encephalopathy	50 (18.0)	25 (21.2)	0.457
Hepatorenal syndrome	22 (7.9)	10 (8.5)	0.851
Gastrointestinal bleeding	57 (20.5)	14 (11.9)	0.040
Ascites	104 (37.4)	31 (26.3)	0.032
Donor factors
Age (yr)	38.8 ± 12.3	41.3 ± 12.8	0.071
Male, n (%)	235 (84.5)	99 (83.9)	0.874
Cause of death, n (%)
Trauma	171 (61.5)	71 (60.2)	0.802
CVA	87 (31.3)	37 (31.4)	0.934
Other	21 (7.6)	10 (8.5)	0.755
DBD (vs DCD)	49 (17.6)	17 (14.4)	0.432
BMI (kg/m2)	22.6 ± 2.6	23.0 ± 2.7	0.169
Graft weight (kg)	1.4 ± 0.3	1.4 ± 0.3	0.228
Macrovesicular steatosis, n (%)	50 (18.0)	22 (18.6)	0.877
Creatinine (μmol/L)	77.0 (56.5-118.5)	82.2 (56.1-121.3)	0.685
Albumin (g/L)	31.0 (28.0-36.5)	30.9 (26.7-36.7)	0.474
TB (μmol/L)	14.1 (9.1-23.4)	16.5 (11.1-26.5)	0.078
AST (U/L)	52.0 (33.0-87.2)	51.5 (31.3-94.5)	0.694
ALT (U/L)	34.0 (22.0-69.0)	39.0 (22.5-76.3)	0.345
Operative factors
WIT (min)	50.7 ± 14.3	47.0 ± 10.8	0.006
CIT (h)	8.4 ± 3.1	8.7 ± 3.4	0.359
Blood loss (L)	1.0 (0.8-2.0)	1.0 (0.8-1.5)	0.117
Immunosuppressant, n (%)
IL2R antibody	204 (73.4)	93 (78.8)	0.254
Corticosteroid	156 (56.1)	58 (49.2)	0.204
Tacrolimus	245 (88.1)	103 (87.3)	0.814

PTDL: Post-transplant dyslipidemia; BMI: Body mass index; MELD: Model for end-stage liver disease; TB: Total bilirubin; INR: International normalized ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TC: Total cholesterol; TG: Triglyceride; HDLC: High-density lipoprotein cholesterol; LDLC: Low density lipoprotein cholesterol; VLDLC: Very low-density lipoprotein cholesterol; FBG: Fasting blood glucose; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; LT: Liver transplantation; AVT: Antiviral treatment; CVA: Cerebral vascular accident; DBD: Donation after brain death; DCD: Donor after circulatory death; WIT: Warm ischemia time; CIT: Cold ischemia time.

Table 2 Comparison of post-transplant complications between post-transplant dyslipidemia and non-post-transplant dyslipidemia groups

	PTDL (n = 278)	Non-PTDL (n = 118)	P value
Acute kidney injury	69 (24.8)	27 (22.9)	0.681
Early allograft dysfunction	84 (30.2)	37 (31.4)	0.822
Portal vein stenosis	5 (1.8)	2 (1.7)	0.943
CMV infection	4 (1.4)	3 (2.5)	0.730
Bacterial infection	28 (10.1)	7 (5.9)	0.184
Diabetes mellitus	21 (7.6)	5 (4.2)	0.233
Hypertension	13 (4.7)	7 (5.9)	0.602
Cardiovascular diseases	7 (2.5)	1 (0.8)	0.490
Chronic kidney failure	3 (1.1)	0 (0)	0.681
Biliary complications	40 (14.4)	15 (12.7)	0.659
HCC recurrence1	60 (55.5)	21 (34.4)	0.008

¹In 169 HCC patients. PTDL: Post-transplant dyslipidemia; CMV: Cytomegalovirus; HCC: Hepatocellular carcinoma.

Table 3 Logistic regression analysis of variables related to post-transplant dyslipidemia

	Univariate		Multivariate
	OR (95% CI)	P value	OR (95%CI)	P value
Overweight	2.726 (1.494-4.973)	0.001	2.705 (1.457-5.020)	0.002
Hyper-TG	7.846 (1.032-59.679)	0.047
Hypo-HDLC	3.116 (1.861-5.217)	< 0.001	3.090 (1.828-5.224)	< 0.001
Hepatitis B	0.489 (0.261-0.915)	0.025
Gastrointestinal bleeding	1.916 (1.021-3.595)	0.043
Ascites	1.677 (1.042-2.701)	0.033
HCC	0.594 (0.385-0.916)	0.019
WIT	2.286 (1.147-4.557)	0.019

Overweight was defined as body mass index > 25 kg/m²; hyper-triglyceride was defined as triglyceride ≥ 200 mg/dL; hypo-high density lipoprotein cholesterol was defined as high density lipoprotein cholesterol < 40 mg/dL. The warm ischemia time and total intravenous fluids were dichotomized at the median into high and low levels. OR: Odds ratio; CI: Confidence interval; TG: Triglyceride; HDLC: High density lipoprotein cholesterol; HCC: Hepatocellular carcinoma; WIT: Warm ischemia time.

Table 4 Multivariate logistic regression analysis of risk factors associated with post-transplant dyslipidemia

		Multivariate	P value
	β	OR (95%CI)
Model 1
Recipient overweight	0.991	2.693 (1.451-4.998)	0.002
Recipient hypo-HDLC	1.134	3.107 (1.838-5.251)	< 0.001
Constant	-0.249
Model 2
Recipient overweight	1.625	3.425 (1.297-9.046)	0.027
Recipient hypo-HDLC	1.231	5.077 (1.206-21.381)	0.013
Low IL-12 (p70) level	1.846	6.336 (2.553-15.726)	< 0.001
Constant	-1.494

Overweight was defined as body mass index > 25 kg/m²; hypo-high-density lipoprotein cholesterol was defined as high-density lipoprotein cholesterol < 40 mg/dL; interleukin-12 (p70) level was dichotomized at the median into high and low levels. OR: Odds ratio; CI: Confidence interval; HDLC: High-density lipoprotein cholesterol.