Evolution of insulin resistance after liver transplantation – a prospective study

Česká verzia

Authors: Irena Míková ¹ ; Erhartová D. ¹; K. Dvořáková ¹ ; Šedivý P. ²; Drobný M. ²; M. Dezortová ² ; M. Hájek ² ; M. Cahová ³ ; H. Daňková ³ ; Sticová E. ⁴; V. Lánská ⁵ ; Pavel Trunečka ¹
Authors place of work: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ¹; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha ²; Centrum experimentální medicíny, IKEM, Praha ³; Pracoviště klinické a experimentální patologie, IKEM, Praha ⁴; Oddělení lékařské statistiky, IKEM, Praha ⁵
Published in the journal: Gastroent Hepatol 2019; 73(4): 287-295
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.14735/amgh2019287

Summary

Introduction: Insulin resistance (IR) plays an important role in the pathogenesis of nonalcoholic fatty liver disease and other diseases. Data regarding the prevalence and evolution of IR in patients before and after liver transplantation (LT) are limited. This prospective study aimed to evaluate the prevalence and evolution of IR in patients before and within 2 years (Y) after LT.

Methods: In 77 patients listed for LT from May 2015 to April 2017, clinical, laboratory, and elastographic evaluations were performed before LT and 6 months (M), 1Y, and 2Y after LT. The liver fat content was also determined by ¹H magnetic resonance (¹H MR) spectroscopy. Liver graft biopsy was performed at 1Y and 2Y after LT.

Results: IR defined as HOMA-IR ≥ 3.0 was found in 26 patients (41.3%) before LT, 16 patients (25.4%) at 6M after LT, 22 patients (34.9%) at 1Y after LT, and 29 patients (46.0%) at 2Y after LT (P = 0.028 for 2Y vs. 6M). Pretransplant IR correlated with age, indication for LT, and the presence of metabolic syndrome. IR at 2Y after LT correlated with the presence of metabolic syndrome, hypertension, and diabetes mellitus, body mass index, the level of gamma-glutamyl transferase, the liver fat content estimated both histologically and by ¹H MR spectroscopy, the grade of ballooning in liver biopsy, and the fibrosis stage estimated by shear wave elastography.

Conclusion: The prevalence of IR is high in patients both before and after LT, and increases significantly with time after LT. Great attention should be paid to posttransplant IR and associated factors.

Submitted: 23. 7. 2019

Accepted: 13. 8. 2019

Conflict of Interest: The authors declare that the article/manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no financial, advisory or other commercial interests in relation to the subject matter.

Publication Ethics: This article/ manuscript has not been published or is currently being submitted for another review.

The authors agree to publish their name and e-mail in the published article/ manuscript.

Dedication: This work was fi nancially supported by grant No. 15-26906A of the Ministry of Health of the Czech Republic.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

nsulin resistance – magnetic resonance – NAFLD

Zdroje

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