Metabolic syndrome in liver transplantation: A preoperative and postoperative concern
Metabolic syndrome in liver transplantation: A preoperative and postoperative concern
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DOI：
10.1016/j.surg.2016.06.015
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发表时间：
2016-10-01
期刊：
影响因子：
3.8
通讯作者：
Diwan, Tayyab
中科院分区：
文献类型：
--
作者：
Chang, Alex L.;Cortez, Alexander R.;Diwan, Tayyab
背景资料。在接受肝移植的患者中，代谢综合征正在增加。非酒精性脂肪性肝炎是代谢综合征的一种表现，也是终末期肝病的一种日益常见的原因，需要进行原位肝移植。我们试图确定术前危险因素对移植后代谢综合征的发展、并发症、再入院和死亡率的影响。我们对2012年5月至2014年4月在我所进行的114例原位肝移植进行了回顾。有代谢综合征的患者(n=19)和无代谢综合征的患者(n=95)在移植时的年龄、种族和终末期肝病的模式方面相似。供体和手术因素在两组之间也是相似的。术前糖尿病被发现与再住院率的增加有关(优势比3.45，P=0.03)。虽然术前代谢综合征本身并不是较差预后的重要预测因子，但术后代谢综合征与第一年再入院人数显著增加有关。预测原位肝移植术后新发代谢综合征的主要因素为术前糖尿病和肥胖(优势比分别为8.54和5.49，P<；0.01)。努力减少原位肝移植术后代谢综合征的发生率可能会减少再入院和改善预后，同时减少资源利用。
Background. Metabolic syndrome is increasing among patients undergoing liver transplantation. Nonalcoholic steatohepatitis is a manifestation of metabolic syndrome and is an increasingly common cause of end-stage liver disease necessitating orthotopic liver transplantation. We sought to determine the effect of preoperative risk factors on the development of post-transplant metabolic syndrome, complications, readmissions, and mortality.Methods. We conducted a review of 114 orthotopic liver transplantations at our institution from May 2012 to April 2014.Results. Patients with (n = 19) and without (n = 95) metabolic syndrome were similar with regard to age, race, and model for end-stage liver disease at time of transplant. Donor and operative factors also were similar between the groups. Preoperative diabetes was found to be associated with an increased rate of readmission (odds ratio 3.45, P = .03). While preoperative metabolic syndrome itself was not a significant predictor of worse outcomes, postoperative metabolic syndrome was associated with significantly greater readmissions in the first year. Major predictors of new onset metabolic syndrome after orthotopic liver transplantation included preoperative diabetes and obesity (odds ratio 8.54 and odds ratio 5.49, P < .01 each).Conclusion. Efforts to decrease the incidence of postoperative metabolic syndrome after orthotopic liver transplantation may decrease readmissions and improve outcomes, along with decreasing resource utilization.