Avest, M. ter (Milou) (2017) Metabolic syndrome after liver transplantation : Differences in the occurrence of metabolic syndrome between patients treated with a calcineurin inhibitor and patients treated with an mTOR inhibitor after liver transplantation. thesis, Medicine.
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Abstract
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.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Guichelaar, Dr. M.M.J and (faculty supervisor) and Gastroenterologist, Medisch Spectrum Twente |
| Supervisor name: | Heinzow, Priv. Doz. Dr. med. H. and Gastroenterologist, Universitätsklinikum Münster and Clinic for Transplantation Medicine, Universitätsklinikum Mü |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2188 |
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