Jonkers, A. (Aniek) (2017) Cardiovascular and metabolic complications following liver transplantation in non-alcoholicsteatohepatitis patients: a 1-year retrospective study. thesis, Medicine.
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Abstract
5 Abstract Background: Non-alcoholic steatohepatitis (NASH) is increasing as indication for liver transplantation (LT) in parallel with the type 2 diabetes mellitus (DMII) and obesity epidemic. NASH is considered as a multisystem disease, which coexists frequently with comorbidities such as DMII, obesity, cardiovascular diseases (CVD), chronic kidney disease (CKD) and metabolic syndrome (MetS). Therefore, complications following LT are expected to be worse compared to non-NASH patients. Up to now, limited information is available about the detailed complications after LT. Because of this, our primary aim was to investigate whether transplanted NASH patients experience more cardiovascular and metabolic complications in a follow-up time of 1 year. Method: In this retrospective study, 169 transplanted adult patients were included for analysis in the period of January 2009 till December 2015. Exclusion was based on acute hepatic failure and non-cirrhotic liver diseases. The diagnosis of NASH was based on: 1) histologic evidence of NASH based on liver biopsy before LT or on explant pathology after LT; 2) pre-cirrhotic imaging demonstrating hepatic steatosis; 3) a phenotypic diagnosis based on the presence of the following criteria: BMI ≥ 30 kg/m2 and diagnosis of DMII (by having HbA1C ≥ 47 mmol/L or the usage of glucose lowering medication) or the presence of the MetS, which is defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) panel. Patient characteristics, medication and immunosuppression use and data to determine metabolic complications (such as MetS, dyslipidaemia, new-onset diabetes after transplantation (NODAT), CKD and non-alcoholic fatty liver disease (NAFLD) recurrence), CVD and malignancies were collected in a follow-up time of 1 year. Data were retrospectively extracted from follow-up-, screening-, outpatient clinic-, imaging-, biopsy reports, laboratory results and liver transplantation sheets. A p-value < 0.05 was considered as statistical significant. Results: The NASH group consisted of 34 patients (20.1%). Patients with NASH cirrhosis were significantly older (59.8 years vs. 55.4 years, p=0.011) and had at 6 months following LT a higher BMI (27.38 vs. 23.88, p=0.000), were more obese (25.8% vs. 4.0%, p=0.011) and had more often DMII (74.2% vs. 34.9%, p=0.000). At 1 year, NASH patients still had a significant higher BMI (28.73 vs. 24.87, p=0.000), were more obese (31.0% vs. 8.1%, p=0.002) and had more MetS (69.0% vs. 33.1%, p=0.000). NASH patients used significant more insulin, statins, beta-blockers and anticoagulants. Non-NASH patients used significant more prednisolone. Patients in the non-NASH group gained significant more weight at 6 months and 1 year (respectively 2.40 kg. vs. 0.00 kg., p=0.001 and 4.45 kg. vs. 2.00 kg., p=0.016). Patient- and graft survival were similar between groups. Conclusion: Patients transplanted for NASH cirrhosis developed significant more MetS, were more obese and used more medication as treatment and prevention for several cardiovascular and metabolic complications. Patient and graft survival were similar between groups.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Dr. J. Blokzijl and Co-supervisors: and Berg, Dr. E.H. van den and Schreuder dr. T.C.M.A. and and and Meijer, dr. V.E. de |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2586 |
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