Stegall M D, Everson G, Schroter G, Bilir B, Karrer F, Kam I
Department of Surgery, University of Colorado School of Medicine, Denver 80262, USA.
Transplantation. 1995 Nov 15;60(9):1057-60.
We retrospectively studied the incidence of diabetes, hypercholesterolemia, hypertension, and obesity in 123 consecutive adult liver transplant recipients (61 men and 62 women) who were alive at least 1 year after transplantation. We also studied the change in these metabolic complications in 61 patients who subsequently were able to be tapered to 5 mg prednisone per day. One year after transplantation--a point at which almost all patients were on maintenance immunosuppression and had stable graft function--the incidence of diabetes was 13% and hypertension was 69.1%. The overall incidence of hypercholesterolemia (serum cholesterol > 240 ng/ml) was 31% and was more frequent in women than in men (38.7% vs. 23.0%, P < 0.06). The incidence of obesity at 1 year was 41.9% in women and 39.3% in men. With tapering of prednisone from 10 mg to 5 mg per day in 61 patients, the mean serum cholesterol decreased from 224.6 +/- 65.2 mg/dl to 203.3 +/- 65.5 mg/dl, P < 0.005. With steroid tapering, 8 patients were able to discontinue antihypertensive medications and 4 were able to discontinue insulin treatment for diabetes. Five patients became obese during the steroid-tapering period. No patient developed irreversible rejection with steroid tapering and no immunologic graft losses occurred more than a year after transplantation. Nine patients who lived a year subsequently died. Of these, 7 patients were diabetic and 2 died of cardiac disease. We conclude that metabolic complications such as diabetes, hypertension, and hypercholesterolemia are common later after liver transplantation and that these may contribute to patient morbidity and mortality. In addition, we conclude steroid tapering to 5 mg/day does not lead to graft loss and may decrease the incidence and severity of late metabolic complications.
我们回顾性研究了123例连续的成年肝移植受者（61例男性和62例女性）糖尿病、高胆固醇血症、高血压和肥胖症的发生率，这些受者在移植后至少存活1年。我们还研究了61例随后能够将泼尼松减至每日5毫克的患者这些代谢并发症的变化。移植后1年——此时几乎所有患者都在接受维持性免疫抑制治疗且移植肝功能稳定——糖尿病的发生率为13%，高血压的发生率为69.1%。高胆固醇血症（血清胆固醇>240 ng/ml）的总体发生率为31%，女性比男性更常见（38.7%对23.0%，P<0.06）。1年时肥胖症的发生率女性为41.9%，男性为39.3%。在61例患者中，随着泼尼松从每日10毫克减至5毫克，平均血清胆固醇从224.6±65.2毫克/分升降至203.3±65.5毫克/分升，P<0.005。随着类固醇减量，8例患者能够停用抗高血压药物，4例患者能够停用糖尿病胰岛素治疗。5例患者在类固醇减量期间变得肥胖。没有患者因类固醇减量出现不可逆排斥反应，移植后1年以上也没有发生免疫性移植丢失。9例存活1年的患者随后死亡。其中，7例患者患有糖尿病，2例死于心脏病。我们得出结论，糖尿病、高血压和高胆固醇血症等代谢并发症在肝移植后期很常见，这些可能导致患者发病和死亡。此外，我们得出结论，将类固醇减至每日5毫克不会导致移植丢失，可能会降低晚期代谢并发症的发生率和严重程度。
