Metabolic disorders in liver transplant patients

Authors

DOI:

https://doi.org/10.52556/2587-3873.2025.2(104).30

Keywords:

liver transplantation, obesity, dyslipidemia, hypertension, metabolic syndrome

Abstract

Overall survival after liver transplantation (LT) has improved significantly in recent decades due to more effective selection of immunosuppressive regimens, improved operative techniques, and perioperative management. Long-term morbidity and mortality after LT remain significant, attributed to the increased incidence of metabolic and malignant complications. Aim: to synthesize data from the specialized literature regarding metabolic disorders developed in patients with liver transplantation. A narrative review of the literature was performed, using databases such as PubMed, Scopus, and Web of Science, relevant to metabolic disorders in LT patients. Metabolic disorders in LT recipients can be inherited from pre-transplant conditions or can develop as a consequence or exacerbation of conventional immunosuppressive regimens (corticosteroids, calcineurin inhibitors, and m-TOR inhibitors), aggravated by an inadequate lifestyle. A multidisciplinary approach to these patients is necessary, with the implementation of a healthy lifestyle, through a reduction in the risk of fat mass increase, balanced diets and limited lipid and protein intake. Metaboli disorders in patients undergoing LT represent the main challenge due to the impact on the long-term outcome. Compliance and monitoring of a hypocaloric diet, structured physical exercise programs should be recommended and implemented for all LT recipients both for the prevention and treatment of metabolic disorders. A personalized approach in the use of immunosuppressive drugs is a key point for avoiding the risk of rejection and metabolic.

References

1. AMIRHOSSEIN, AZHIE, SHETH, PRIYA, HAMMAD, AHMED et al. Metabolic Complications in Liver Transplantation Recipients: How We Can Optimize LongTerm Survival. Liver Transpl. 2021 Oct;27(10):1468-1478. https://doi.org/10.1002/lt.26219

2. AHMED, S., H, BIDDLE, K., AUGUSTINE, T., AZMI, S. Post-transplantation diabetes mellitus. Diabetes Ther. 2020;11(4):779-801. https://doi.org/10.1007/s13300-020-00790-5

3. ANASTACIO, L. R., FERREIRA, L. G., RIBEIRO, H.S. et al. Sarcopenia, obesity and sarcopenic obesity in liver transplantation: a body composition prospective study. Arq Bras Cir Dig. 2019 Apr 29;32(2):e1434. https://doi.org/10.1590/0102-672020190001e1434

4. ANASTACIO, L.R., LIMA, A. S., TOULSON DAVISSON., CORREIA, M.I. Metabolic syndrome and its components after liver transplantation: incidence, prevalence, risk factors, and implications. Clin Nutr. 2010;29(2):175-179. https://doi.org/10.1016/j.clnu.2009.08.008

5. ASRANI, S. K., SARACINO, G., O'LEARY, J.G., GONZALEZ, S., KIM, P.T. et al. Recipient characteristics and morbidity and mortality after liver transplantation. J. Hepatol.2018 Jul;69(1):43-50. https://doi.org/10.1016/j.jhep.2018.02.004

6. BATSIS, J.A., VILLAREAL, D.T. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018 Sep;14(9):513-537. https://doi.org/10.1038/s41574-018-0062-9

7. BECKMANN, S., DENHAERYNCK, K., STAMPF, S. et al. New-onset obesity after liver transplantation-outcomes and risk factors: the Swiss Transplant Cohort Study. Transpl Int. 2018 Nov;31(11):1254-1267. https://doi.org/10.1111/tri.13308

8. BRODOSI, L., PETTA, S., PETRONI, M.L., MARCHESINI,G. et al. Management of Diabetes in Candidates forLiver Transplantation and in Transplant Recipients.Transplantation. 2022 Mar 1;106(3):462-478. https://doi.org/10.1097/TP.0000000000003867

9. DADLANI, A., LEE, T.-H. Management of metabolic syndrome after liver transplant. Clin Liver Dis (Hoboken). 2023 May 16;21(6):155-159. https://doi.org/10.1097/CLD.0000000000000040

10. DARENDELILER, F. IUGR: Genetic influences, metabolic problems, environmental associations/triggers, current and future management. Best Pract Res Clin Endocrinol Metab. 2019 Jun;33(3):101260. https://doi.org/10.1016/j.beem.2019.01.001

11. DELGADO-LISTA, J., ALCALA-DIAZ, J.F., TORRESPEÑA, J.D., QUINTANA-NAVARRO et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022 May 14;399(10338):1876-1885. https://doi.org/10.1016/S0140-6736(22)00122-2

12. DI STEFANO, C., VANNI, E., MIRABELLA, S. et al. Risk factors for hypertension after liver transplantation. J. Am. Soc. Hipertens. 2018, 12, 220-229. https://doi.org/10.1016/j.jash.2018.01.002

13. DUNN, M.A., ROGAL, S.H. S., ROJO, A.D., et al. Physical Function, Physical Activity, and Quality of Life After Liver Transplantation. Liver Transpl. 2020 May;26(5):702-708. https://doi.org/10.1002/lt.25742

14. FILIPPO GABRIELLI, LUCIA GOLFIERI, FABIO NASCIMBENI, PIETRO ANDREONE et al. Metabolic Disorders in Liver Transplant Recipients: The State of the Art J. Clin. Med. 2024, 13, 1014. https://www.mdpi.com/journal/jcm https://doi.org/10.3390/jcm13041014

15. GITTO, S.; FALCINI, M., MARRA, F. MEDITRA Rearch Group. Metabolic Disorders After Liver Transplantation. Metab Syndr Relat Disord. 2021 Mar;19(2):65-69. https://doi.org/10.1089/met.2020.0068

16. GITTO, S., MANNELLI, N., TASSI, A., GABRIELLI, F. et al. Liver transplantation and nonalcoholic steatohepatitis: the state of the art. Metab Target Organ Damage 2022;2:7 https://doi.org/10.20517/mtod.2022.04

17. GOLFIERI, L., GITTO, S., VUKOTIC, R., ANDREONE, P. et al. Impact of psychosocial status on liver transplant process. Ann Hepatol. 2019 Nov-Dec;18(6):804-809. https://doi.org/10.1016/j.aohep.2019.06.011

18. HAN, MAT., OLIVO, R., CHOI, C.J., PYRSOPOULOS, N. De novo and recurrence of metabolic dysfunctionassociated fatty liver disease after liver transplantation. World J Hepatol. 2021 Dec 27;13(12):1991-2004. https://doi.org/10.4254/wjh.v13.i12.1991

19. JENSSEN, T., HARTMANN, A. Post-transplant diabetesmellitus in patients with solid organ transplants. Nat Rev Endocrinol. 2019 Mar;15(3):172-188. https://doi.org/10.1038/s41574-018-0137-7

20. JIMÉNEZ-PÉREZ M., GONZÁLEZ-GRANDE, R., OMONTE GUZMÁN, E., AMO TRILLO V. et al. Metabolic complications in liver transplant recipients. World J Gastroenterol. 2016 Jul 28; 22(28):6416-6423. https://doi.org/10.3748/wjg.v22.i28.6416

21. KHUSH, K. K., CHERIKH, W.S., CHAMBERS, D.C. et al. International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019 https://doi.org/10.1016/j.healun.2019.08.004

focus theme: donor and recipient size match. J Heart Lung Transplant. 2019;38(10):1056-1066. https://doi.org/10.1016/j.healun.2019.08.004

22. LAISH, I., BRAUN, M., MOR, E., SULKES, J. et al. Metabolic Syndrome in Liver Transplant Recipients: Prevalence, Risk Factors, and Association with Cardiovascular Events. Liver Transplant. Liver Transpl. 2011 Jan;17(1):15-22. https://doi.org/10.1002/lt.22198

23. MAGISTRI, P., MARZI, L., GUERZONI, S., VANDELLI, M. et al. Impact of a Multidisciplinary Team on Alcohol Recidivism and Survival After Liver Transplant for Alcoholic Disease. Transplant Proc. 2019 Jan-Feb;51(1):187-189. https://doi.org/10.1016/j.transproceed.2018.02.212

24. MAMATHA, BHAT., SHIRINE, E., USMANI, AMIRHOSSEIN AZHIE. et al. Metabolic Consequences of Solid Organ Transplantation. Endocr Rev. 2021 Mar 15;42(2):171-197. https://doi.org/10.1210/endrev/bnaa030

25. NAIR, S., VERMA, S., THULUVATH, P. J. Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology. 2002;35(1):105-109. https://doi.org/10.1053/jhep.2002.30318

26. ODENWALD, M.A., ROTH, H.F., RETICKER, A., SEGOVIA, M. et al. Evolving challenges with long-term care of liver transplant recipients. Clin Transplant. 2023 Oct;37(10):e15085. https://doi.org/10.1111/ctr.15085

27. RICHARDS, J., GUNSON, B., JOHNSON, J., NEUBERGER, J. Weight gain and obesity after liver transplantation. Transpl Int. 2005 Apr;18(4):461-466. https://doi.org/10.1111/j.1432-2277.2004.00067.x

28. ROCCARO, G.A., GOLDBERG, D.S., HWANG, W.-T., JUDY, R. et al. Sustained Posttransplantation Diabetes Is Associated With Long-Term Major Cardiovascular Events Following Liver Transplantation. Am J Transplant. 2018 Jan;18(1):207-215. https://doi.org/10.1111/ajt.14401

29. ROMANOWSKI, M., DZIEDZIEJKO, V., MACIEJEWSKA-KARLOWSKA, A., et al. Adiponectin and leptin gene polymorphisms in patients with posttransplant diabetes mellitus. Pharmacogenomics. 2015;16(11):1243-51. https://doi.org/10.2217/pgs.15.71

30. SAVIOL, G., SURBONE, S., GIOV, I. et al. Early development of metabolic syndrome in patients subjected to lung transplantation. Clin Transplant. 2013 MayJun;27(3):E237-43. https://doi.org/10.1111/ctr.12098

31. SHIVASWAMY, V., BOERNER, B., LARSEN, J. Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes. Endocr Rev. 2016 Feb;37(1):37-61. https://doi.org/10.1210/er.2015-1084

32. SILVA, A. C., NOGUEIRA, P., MACHADO, M.V. Hepatic steatosis after liver transplantation: a systematic review and meta-analysis. Liver Transpl. 2023 Apr 1;29(4):431-448. https://doi.org/10.1097/LVT.0000000000000060

33. SMITH, U. Abdominal obesity: a marker of ectopic fat accumulation. J Clin Invest. 2015 May 1;125(5):1790-1792. https://doi.org/10.1172/JCI81507

34. SPIRITOS, Z., ABDELMALEK, M. F. Metabolic syndrome following liver transplantation in nonalcoholic steatohepatitis. Transl Gastroenterol Hepatol. 2021 Jan 5:6:13. https://doi.org/10.21037/tgh.2020.02.07

35. TONG, M.-S., CHAI, H.-T., LIU, W.-H., CHEN, C.-L. et al. Prevalence of hypertension after living-donor liver transplantation: a prospective study. Transplant Proc. 2015 Mar;47(2):445-50. https://doi.org/10.1016/j.transproceed.2014.10.050

36. VARSHNEY, M., DHINGRA, K., CHOUDHURY, A. Psychosocial Assessment and Management-related Issues Among Liver Transplant Recipients. J Clin Exp Hepatol. 2024 Jan-Feb;14(1):101261. https://doi.org/10.1016/j.jceh.2023.07.414

37. VAUGHN, V. M., CRON, D. C., TERJIMANIAN, M. N. et al. Analytic morphomics identifies predictors of newonset diabetes after liver transplantation. Clin Transplant. 2015 May;29(5):458-64. https://doi.org/10.1111/ctr.12537

38. VILLERET, F., DHARANCY, S., ERARD, D., ABERGEL, A. et al. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis. JHEP Rep. 2023 Jan 3;5(3):100668. https://doi.org/10.1016/j.jhepr.2022.100668

39. VON DÜRING, M. E., JENSSEN, T., BOLLERSLEV, J., ÅSBERG, O., et al. Visceral fat is strongly associated with post-transplant diabetes mellitus and glucose metabolism 1 year after kidney transplantation. Clin Transplant. 2017 Jan;31(1). https://doi.org/10.1111/ctr.12869

40. YANG, C.; JIA, X., WANG, Y., FAN, J. et al. Trends and influence factors in the prevalence, intervention, and control of metabolic syndrome among US adults, 1999-2018. BMC Geriatr. 2022 Dec 19;22(1):979. https://doi.org/10.1186/s12877-022-03672-6

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2025-12-01

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No. 2(104) (2025): Supliment. Al VI-lea Congres Național de Gastroenterologie și Hepatologie din Republica Moldova cu participare internațională

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How to Cite

[1]
Taran, N. et al. 2025. Metabolic disorders in liver transplant patients. Public Health Economy and Management in Medicine. 2(104) (Dec. 2025), 167–172. DOI:https://doi.org/10.52556/2587-3873.2025.2(104).30.

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