Cigrovski Berkovic M, Šeša V, Balen I, Lai Q, Silovski H, Mrzljak A. Key challenges of post-liver transplant weight management. World J Transplant 2024; 14(4): 95033 [DOI: 10.5500/wjt.v14.i4.95033]
Corresponding Author of This Article
Maja Cigrovski Berkovic, MD, PhD, Assistant Professor, Department for Sport and Exercise Medicine, University of Zagreb, Faculty of Kinesiology, Horvacanski Zavoj 15, Zagreb 10000, Croatia. maja.cigrovskiberkovic@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Transplant. Dec 18, 2024; 14(4): 95033 Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.95033
Key challenges of post-liver transplant weight management
Maja Cigrovski Berkovic, Vibor Šeša, Ivan Balen, Quirino Lai, Hrvoje Silovski, Anna Mrzljak
Maja Cigrovski Berkovic, Department for Sport and Exercise Medicine, University of Zagreb, Faculty of Kinesiology, Zagreb 10000, Croatia
Vibor Šeša, Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Ivan Balen, Department of Gastroenterology and Endocrinology, General Hospital “Dr. Josip Bencevic”, Slavonski Brod 35000, Croatia
Quirino Lai, General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome 00018, Italy
Hrvoje Silovski, Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
Anna Mrzljak, Department of Medicine, University of Zagreb, School of Medicine, Zagreb 10000, Croatia
Author contributions: Cigrovski Berkovic M and Mrzljak A contributed to the conception and design of the study; Balen I, Lai Q, Sesa V contributed to the acquisition of data; Lai Q, Šeša and Silovski H analyzed and interpreted the data; Cigrovski Berkovic M, Balen I and Šeša V drafted the article; Lai Q critically revised the manuscript; All authors approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maja Cigrovski Berkovic, MD, PhD, Assistant Professor, Department for Sport and Exercise Medicine, University of Zagreb, Faculty of Kinesiology, Horvacanski Zavoj 15, Zagreb 10000, Croatia. maja.cigrovskiberkovic@gmail.com
Received: March 30, 2024 Revised: August 21, 2024 Accepted: September 9, 2024 Published online: December 18, 2024 Processing time: 173 Days and 19 Hours
Abstract
Liver transplantation serves as a life-saving intervention for patients with end-stage liver disease, yet long-term survival remains a challenge. Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis, metabolic syndrome and de-novo malignancy development. This review synthesizes current literature on prevalence, risk factors and management strategies for post-liver transplant obesity, emphasizing its impact on graft and patient survival. Literature review consultation was conducted in Medline/PubMed, SciELO and EMBASE, with the combination of the following keywords: Weight management, liver transplantation, immunosuppressive therapy, lifestyle interventions, bariatric surgery. Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients, yet it seems to have lesser effect on post-transplant obesity development than previously thought. However, it significantly contributes to the development of other components of metabolic syndrome. Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index, a history of alcoholic liver disease, hepatocellular carcinoma, male gender, the absence of cellular rejection and the marital status of the recipient. Tailored immunosuppressive regimens, pharmacotherapy, lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients. Timely identification and intervention thus hold paramount importance. Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.
Core Tip: The onset of obesity in post-liver transplant recipients significantly influences both graft longevity and liver transplant patient morbidity and mortality. Key predisposing factors for post-transplant obesity encompass elevated recipient and donor body mass index, a history of alcoholic liver disease, hepatocellular carcinoma, male gender, the absence of cellular rejection and the marital status of the recipient. Tailored approaches to immunosuppression, pharmacological management of obesity, bariatric surgical interventions and lifestyle modifications represent pivotal modalities in the therapeutic armamentarium for this patient cohort.
