Weight Gain and De Novo Metabolic Disorders after Liver Transplantation

The development of nutritional and metabolic abnormalities represents an important burden in patients after liver transplantation (LT). Our study aimed at evaluating the incidence, time of onset, and risk factors for nutritional and metabolic abnormalities in patients after LT. The study was a single-center retrospective study. Consecutive patients undergoing elective LT from 2000 to 2016 were enrolled. The presence of at least two among arterial hypertension (AH), diabetes mellitus (DM), dyslipidemia, and obesity (BMI ≥ 30 Kg/m2) was utilized to define patients with the metabolic disorder (MD). Three hundred and fifteen patients were enrolled; the median age was 56 years (68% males). Non-alcoholic steatohepatitis (NASH) was the origin of liver disease in 10% of patients. During follow-up, 39% of patients developed AH, 18% DM, and 17% dyslipidemia. Metabolic disorders were observed in 32% of patients. The NASH etiology (OR: 6.2; CI 95% 0.5–3; p = 0.003) and a longer follow-up (OR: 1.2; CI 95% 0.004–0.02; p = 0.002) were associated with de novo MD. In conclusion, nutritional and metabolic disorders are a frequent complication after LT, being present in up to one-third of patients. The NASH etiology and a longer distance from LT are associated with de novo MD after LT.

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A207 DE NOVO DONOR-SPECIFIC ANTIBODY FORMATION IN LIVER TRANSPLANTS: RISK FACTORS FOR DEVELOPMENT AND IMPACT ON GRAFT SURVIVAL.

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.205 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 236-237

Author(s):

C Wang ◽

A J Montano-Loza ◽

P M Campbell ◽

V Bain

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Disease ◽

Organ Transplantation ◽

Graft Survival ◽

Patient Survival ◽

De Novo ◽

Single Center ◽

Liver Transplants ◽

Post Transplant

Abstract Background Antibody mediated rejection (AMR) is an area of great importance in solid organ transplantation. Donor-specific antibodies (DSA) have emerged as relevant biomarkers in predicting graft function and survival. DSA detected post-transplant may either be preformed or de novo and emerging evidence suggests de novo DSA, in particular, is associated with inferior graft outcomes. In contrast to the clear role that AMR plays in renal and thoracic organ transplantation, its importance in liver transplants remains controversial. Aims The aim of this study was to determine the risk factors associated with de novo DSA formation and to evaluate its role in determining clinical outcomes after liver transplantation. Methods This single-center retrospective study compiled data on liver transplants performed between 2005 and 2019 in Edmonton, Canada. Data collected from medical charts included gender, age at transplant, reason for transplant, and immunosuppressive regimens, among several others. The presence of DSA was determined by single antigen flow beads until 2009 and by Luminex thereafter. Potential predictors of DSA formation were evaluated using Cox proportional hazard models. Graft survival estimates were obtained using the Kaplan-Meier method and comparisons between patient groups were conducted using the log-rank test. Results Between 2005–2019, 131 patients had measurements of DSA both before and after liver transplantation. In this cohort, 17 patients (13%) tested negative on DSA screening before transplant but developed new antibodies against either Class I or Class II molecules post-transplant. Risk factor analysis revealed transplants performed in the setting of autoimmune liver disease (PSC, PBC, and autoimmune hepatitis) had higher risks of developing de novo DSA post-transplant (p=0.002. See Table 1). Graft survival probability at 5- and 10-years was 72% and 61% in those with de novo DSA formation, compared to 93% and 89% in patients without de novo DSA formation (p=0.04. See Figure 1). Overall patient survival was similar between the two groups. Conclusions In this single-center study, a transplant done in the setting of autoimmune liver disease had a higher risk of de novo DSA formation. Furthermore, de novo DSA formation lead to a decreased graft survival time in liver transplant patients but overall patient survival was not significantly decreased. A standard approach to DSA monitoring, especially in high risk populations, is required to better understand its prevalence and impact in liver transplantation. Funding Agencies None

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P140 Factors associated with development of NAFLD in patients with inflammatory bowel disease: a 5-year retrospective study on 225 patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.269 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S207-S208

Author(s):

V Domislović ◽

I Knežević-Štromar ◽

M Premužić ◽

M Brinar ◽

D Vranešić Bender ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Liver Disease ◽

Liver Fibrosis ◽

Obese Patients ◽

Logrank Test ◽

Factors Associated ◽

Advanced Liver Fibrosis ◽

Disease Specific

Abstract Background Patients with IBD are at higher risk for non-alcoholic fatty liver disease (NAFLD) comparing to general population. Complex pathogenesis of NAFLD in IBD may be related to disease-specific risk factors such as chronic inflammation, steroid exposure, drug induced hepatotoxicity, malnutrition and alteration of gut microbiota, which is emerging as a major factor in the pathogenesis of NAFLD. The goal of the study was to investigate factors associated with NADLF and advanced liver fibrosis (ALF) in patients with CD and UC. Methods This is a retrospective study on IBD patients without extraintestinal manifestations and known liver disease. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36, and ALF was defined as FIB-4 ≥ 2.67. Predictors of NAFLD development were analysed using Kaplan–Meier and Cox regression analyses. Results In this retrospective study, we have included 225 IBD patients; 72.4% (n = 163) patients with CD and 27.6% (n = 62) patients with UC (median age 41.2 yr, 53.7% males) which were observed for a median of 4.6 years. There were 63.1% (n = 142) patients with normal BMI, 27.6% (n = 62) overweight and 9.3% (n = 21) obese patients. Obese patients had the highest HIS score 43.9 ± 5.9, following with overweight 37.8 ± 5.7 and normal BMI 30 ± 4.3 kg/m2, p < 0.001. During the follow-up obese and overweight patients had higher risk of developing NAFLD comparing to patients with normal BMI (obese HR = 11.1 95% CI 4.3–28.3 and overweight HR = 5.55 95% CI 3.4–9.1, Logrank test p < 0.001) (Figure 1). Regarding FIB-4 score there, was no difference among different BMI categories (p = 0.192), and there was no difference in ALF development in the follow-up period (Logrank test p = 0.91). In Cox proportional-hazards regression significant predictors for NAFLD development were dyslipidaemia HR=2.11, 95% CI 1.2–3.7, overweight HR=6 95% CI 3.6–10, and obesity HR=13.4, 95% CI 7–35. Conclusion NAFLD is frequent comorbidity in patients with CD and UC, which can lead to development of advanced liver fibrosis. Our results show that patients with IBD have a high risk of NAFLD development, whereas the increased risk for ALF was not observed. Overweight and obese patients and those with dyslipidemia should be closer monitored due to significantly higher risk of NAFLD. This study points out the complexity disease-specific risk factors and importance of better stratifying IBD patients at risk of NAFLD and advanced liver fibrosis.

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The 28-year incidence of de novo malignancies after liver transplantation: A single-center analysis of risk factors and mortality in 1616 patients

Liver Transplantation ◽

10.1002/lt.24795 ◽

2017 ◽

Vol 23 (11) ◽

pp. 1404-1414 ◽

Cited By ~ 12

Author(s):

Sebastian Rademacher ◽

Daniel Seehofer ◽

Dennis Eurich ◽

Wenzel Schoening ◽

Ruth Neuhaus ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

De Novo ◽

Single Center

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Incidence and Risk Factors of Posttransplantation Diabetes Mellitus in Living Donor Kidney Transplantation: A Single-Center Retrospective Study in China

Transplantation Proceedings ◽

10.1016/j.transproceed.2018.08.007 ◽

2018 ◽

Vol 50 (10) ◽

pp. 3381-3385 ◽

Cited By ~ 5

Author(s):

J. Xu ◽

L. Xu ◽

X. Wei ◽

X. Li ◽

M. Cai

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Kidney Transplantation ◽

Retrospective Study ◽

Living Donor ◽

Single Center ◽

Donor Kidney ◽

Living Donor Kidney Transplantation ◽

Donor Kidney Transplantation ◽

Living Donor Kidney

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Post-Transplant Diabetes Mellitus in Kidney Transplant Recipients: A Multi-Center Study

Kidney360 ◽

10.34067/kid.0000862021 ◽

2021 ◽

pp. 10.34067/KID.0000862021

Author(s):

Rubab F. Malik ◽

Yaqi Jia ◽

Sherry G. Mansour ◽

Peter P. Reese ◽

Isaac E. Hall ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Kidney Transplant ◽

Graft Failure ◽

De Novo ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Kidney Recipients ◽

Recipient Age

Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single-center with various approaches to outcome ascertainment. Methods: In a multi-center longitudinal cohort of 632 non-diabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics such as sex, HCV infection, and kidney donor profile index (KDPI) and recipient characteristics such as age, race, BMI, and increased HLA mismatches would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression. Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age (p<0.001) and higher BMI (p=0.006). PTDM was not associated with all-cause graft failure [adjusted Hazard Ratio (aHR) 1.10 (95% CI: 0.78-1.55)], death-censored graft failure [aHR 0.85 (0.53-1.37)], or death [aHR 1.31 (0.84-2.05)] at median follow-up of 6 (4.0,6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM. Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to short follow-up.

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Long-term follow-up of de novo allergy in pediatric liver transplantation - 10 yr experience of a single center

Pediatric Transplantation ◽

10.1111/petr.12051 ◽

2013 ◽

Vol 17 (3) ◽

pp. 251-255 ◽

Cited By ~ 16

Author(s):

Yoon Lee ◽

Yoo Min Lee ◽

Mi Jin Kim ◽

Suk Koo Lee ◽

Yon Ho Choe

Keyword(s):

Liver Transplantation ◽

De Novo ◽

Pediatric Liver Transplantation ◽

Single Center ◽

Pediatric Liver ◽

Long Term Follow Up

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25 Year Incidence of De Novo Malignancies After Liver Transplantation: A Single-Center Analysis of Risk Factors and Mortality in 1179 Patients.

Transplantation Journal ◽

10.1097/00007890-201407151-00527 ◽

2014 ◽

Vol 98 ◽

pp. 173

Author(s):

S. Rademacher ◽

M. Hippler-Benscheidt ◽

R. Neuhaus ◽

T. Denecke ◽

G. Puhl ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

De Novo ◽

Single Center

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Perioperative risk factors of progressive chronic kidney disease following liver transplantation: analyses of a 10-year follow-up single-center cohort

Annals of Surgical Treatment and Research ◽

10.4174/astr.2020.99.1.52 ◽

2020 ◽

Vol 99 (1) ◽

pp. 52

Author(s):

Kyungho Lee ◽

Junseok Jeon ◽

Jong Man Kim ◽

Gaabsoo Kim ◽

Kyunga Kim ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Liver Transplantation ◽

Kidney Disease ◽

Perioperative Risk ◽

Single Center ◽

Perioperative Risk Factors

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Recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032001000400007 ◽

2001 ◽

Vol 38 (4) ◽

pp. 247-253 ◽

Cited By ~ 7

Author(s):

Raquel F. Liermann GARCIA ◽

Eugenia MORALES ◽

Christian Evangelista GARCIA ◽

Sushma SAKSENA ◽

Stefan G. HÜBSCHER ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Disease ◽

Orthotopic Liver Transplantation ◽

De Novo ◽

Fatty Infiltration ◽

Alcoholic Steatohepatitis ◽

Early Fibrosis ◽

End Stage

Background — Non-alcoholic steatohepatitis was coined in 1980 to describe pathological and clinical features of non-alcoholic disease associated with pathological features, commonly seen in alcoholic-liver disease itself. It is now a well-recognised cause of end-stage liver disease and a rare cause of orthotopic liver transplantation. A small number of cases with recurrent non-alcoholic steatohepatitis following liver transplantation have been reported, however de novo non-alcoholic steatohepatitis in the liver allograft is not well recognised. Aims/Results - We report four cases of non-alcoholic steatohepatitis following orthotopic liver transplantation describing the factors related with the pathology. The recurrence of fatty infiltration occurred within 21 months and transition from mild steatosis to non-alcoholic steatohepatitis and early fibrosis was observed within 60 months post transplant in all four patients. All four cases had association with one or multiples risk factors (obesity, type 2 diabetes and/or hyperlipidemia). Conclusions - Management of this risk factors may play a therapeutic role in the prevention of recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation.

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