Gebhardt Sabine, Jara Maximilian, Malinowski Maciej, Seehofer Daniel, Puhl Gero, Pratschke Johann, Stockmann Martin
1 Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.
Transplantation. 2015 Jun;99(6):1243-9. doi: 10.1097/TP.0000000000000499.
Metabolic disorders are common complications after orthotopic liver transplantation (OLT) and may lead to increased morbidity and mortality.
Fasting glucose and lipid metabolism, and body weight of 81 patients undergoing primary OLT were prospectively analyzed. Patients were investigated preoperatively, on postoperative days 1, 3, 5, 10, 14, 28 as well as 6 months and 1 year after OLT. Data of nonfasted patients were excluded from the analysis. Standardized definitions and classifications for diabetes mellitus (DM), body mass index (BMI), and dyslipidemia were used.
Prevalence of new-onset diabetes after transplantation was 9.3%, and obesity was its only independent risk factor (odds ratio [OR], 16.5). Preoperative impaired glucose homeostasis (OR, 10.8) and initial poor graft function (OR, 6.89) were independent risk factors for postoperative DM. Maximum prevalence of hypertriglyceridemia and hypercholesterolemia was found on postoperative day 10 and 6 months post-OLT, respectively. Risk factors for hypercholesterolemia at 1 year were patient age (OR, 1.17) and postoperative renal dysfunction (OR, 16.33). Higher preoperative BMI was a risk factor for postoperative hypertriglyceridemia (OR, 1.17). Overall body weight and BMI significantly decreased over 1 year (P < 0.05). Prevalence of obesity was 22.2% before and 20.9% after OLT.
For the first time, initial poor graft function was identified as a risk factor for post-OLT DM. By ruling out any exogenous factors influencing metabolism, we believe we were able to show the true prevalence of metabolic disorders and therefore provided a valuable contribution to the identification of potential risk factors.
代谢紊乱是原位肝移植（OLT）术后常见的并发症，可能导致发病率和死亡率增加。
对81例接受初次OLT的患者的空腹血糖和脂质代谢以及体重进行前瞻性分析。在术前、OLT术后第1、3、5、10、14、28天以及6个月和1年后对患者进行调查。非空腹患者的数据被排除在分析之外。使用糖尿病（DM）、体重指数（BMI）和血脂异常的标准化定义和分类。
移植后新发糖尿病的患病率为9.3%，肥胖是其唯一的独立危险因素（比值比[OR]，16.5）。术前葡萄糖稳态受损（OR，10.8）和初始移植肝功能不良（OR，6.89）是术后DM的独立危险因素。高甘油三酯血症和高胆固醇血症的最高患病率分别在术后第10天和OLT后6个月发现。1年后高胆固醇血症的危险因素是患者年龄（OR，1.17）和术后肾功能不全（OR，16.33）。术前较高的BMI是术后高甘油三酯血症的危险因素（OR，1.17）。总体体重和BMI在1年内显著下降（P<0.05）。肥胖的患病率在OLT前为22.2%，OLT后为20.9%。
首次将初始移植肝功能不良确定为OLT术后DM的危险因素。通过排除任何影响代谢的外源性因素，我们认为我们能够显示代谢紊乱的真实患病率，因此为识别潜在危险因素做出了有价值的贡献。
