In recent years, advances in surgical techniques as well as immunosuppressive drugs have increased the success of transplant surgery and the longevity of patients after liver transplant. The majority of liver transplant recipients need lifelong immunosuppression, mostly based on tacrolimus, cyclosporine or sirolimus with or without steroids which are associated with increasing risk of metabolic syndrome components like hypertension, diabetes mellitus, and hyperlipidemia and also increased risk of CVD. (11) Therefore, the prevention and management of long-term complications have become increasingly important in the success of liver transplant. Weight gain beyond normal levels, obesity and impaired lipid profiles are known to be common complications after surgery in patients with liver transplant. Post liver transplant diabetes is a well-known disorder is associated with impaired graft tissue function, increased risk of infection and CVD. (12,13)
Post-transplant metabolic disorder can lead to CVD and is associated with increased post-transplant mortality. In their study, Laish et al., reported a 59.1% prevalence of post-transplant metabolic disorders that was twice that in the normal population (13). In our center the rate of metabolic syndrome after liver transplant in children was 50.2% (7). Therefore, identifying the risk factors associated with these syndrome is recognized as an important issue in patients' long-life span.
In the Husing study, hyperlipidemia was observed in 45% of patients with or without immunosuppressive drugs. (15) In our center the rate of hypertriglyceridemia and
hypercholesterolemia in a combine pediatric and adult series were 70% and 15.3%, respectively. Age, sex, BMI, and underlying liver disease were not predictors of hypertriglyceridemia or hypercholesterolemia. Post-transplant hypertriglyceridemia was significantly more common in patients receiving tacrolimus than in those receiving cyclosporine (p=0.040), but post-transplant hypercholesterolemia had no significant correlation with type of immune suppression. (16)
In the present study, the most common immune suppressive medication was tacrolimus followed by prednisolone, mycophenolate and sirolimus. Immunosuppressive drugs usage in the present study in both gender, different age categories, as well as type of graft didn’t show any difference.
A recent study in pediatric liver transplant recipients showed that post-transplant metabolic syndrome and its components were common as 28% of children and young adults were overweight or obese, and 35% have pre-hypertension or hypertension, 44% have pre-diabetes, and 37% have low HDL. (17) In the present study prediabetes and diabetes were seen in 6.1% and 1.7% of the patients, respectively and 65.6% of them had low HDL.
Pinto et al. evaluated the effect of diet on reducing lipid profiles in 53 patients with liver transplant, and their results showed that post-transplant TC, LDL and TG profiles were significantly decreased by dietary intervention. The mean of each of these profiles was 160, 84.2 and 150 mg/dL for boys and 169, 95.8 and 123.5 mg/dL for girls, respectively (10).
In a study on 165 adults liver recipients the lipid profiles were compare between the two groups of recipients (LD and DD) and showed that LDLT recipient had lower fasting glucose (4.85 vs. 7.21 mmol/L, p < 0.001) and TG (0.87 vs. 1.22 mmol/L, p = 0.016) but higher HDL (1.58 vs. 1.39 mmol/L, p = 0.022) and the authors concluded that LDLT recipients had better lipid profiles than DDLT recipients. (18)
The results of this study showed that the mean levels of FBS, TG, TC and LDL were higher in patients with transplant from DD, and the mean HDL level was lower in these patients, whereas these differences were significant only in TG and HDL profiles. FBS and HDL levels increased and decreased with age, respectively. Also, the levels of TG and HDL factors were significantly correlated with the type of tissue graft used. Patients who received a transplanted organ from a LR donor have a significantly lower TG and higher HDL and a lower risk of CVD.
According to results of this study we can suggest that DDLT recipients need more closely lipid profile monitoring.