Metabolic syndrome before liver transplantation: does it have an impact on post liver transplantation outcome?

Introduction: metabolic syndrome (MS) and cardiovascular risk factors are common in liver transplant (LT) candidates and recipients. Cardiovascular events and de novotumors are increasingly common causes of mortality inliver transplant recipients. The aims of this study were i)to assess the prevalence of MS in LT recipients and itsgrowth over the years, and ii) to determine if the presenceof MS pre-LT is associated with a higher risk of post-LTcardiovascular events (CVE), de novo tumors, or early andlate survival.Patients and methods: a retrospective study was performedthat included LT recipients from January 2012 to December2017. Baseline features (MS before LT and at 1year post-LT)and outcomes (CVE, de novo tumors and survival) wererecorded. Results: a total of 483 recipients were included, MS waspresent in 20 % of pre-LT subjects with an increasingprevalence over time, from 16 % in 2012 to 34 % in 2017(p = 0.025). One-year post-LT, an additional 12 % had developed de novo MS. At a median of 56 months of follow-up,13 % developed a CVE and 9 % a de novo tumor. One and5-year survival rates were 91 % and 83 % in those with preLT MS, and 93 % and 85 % in those without it (p = 0.94). Thepresence of MS before LT was independently associatedwith a higher risk of post-LT CVE (HR: 2.66, 95 % CI: 1.6-4.4,p < 0.001) but not with de novo tumors (p = 0.94) nor earlyand late survival (p = 0.58 and p = 0.87).Conclusion: pre-LT MS is increasing among LT candidatesand is associated with a higher risk of post-LT morbidity(CVE) yet without affecting mortality. (AU)

Metabolic syndrome before liver transplantation: does it have an impact on post liver transplantation outcome?

INTRODUCTION: Metabolic syndrome (MS) and cardiovascular risk factors are common in liver transplant (LT) candidates and recipients. Cardiovascular events and de novo tumors are increasingly common causes of mortality in liver transplant recipients. The aim of this study were (i) assess the prevalence of MS in LT recipients and its growth over the years and (ii) determine if the presence of MS pre-LT is associated with a higher risk of post-LT cardiovascular events (CVE), de novo tumors or early and late survival. PATIENTS AND METHODS: A retrospective study was performed that included LT recipients from January 2012 to December 2017. Baseline features (MS before LT and at 1year post-LT) and outcomes (CVE, de novo tumors and survival) were recorded. RESULTS: 483 recipients were included, MS was present in 20% of pre-LT with an increasing prevalence over time, from 16% in 2012 to 34% in 2017 (p=0.025). One-year post-LT, an additional 12% had developed de novo MS. At a median of 56-months follow-up, 13% developed a CVE and 9% a de novo tumor. One and 5-yr survival rates were 91% and 83% in those with pre-LT MS and 93% and 85% in those without (p=0.94).The presence of MS before LT was independently associated with a higher risk of post-LT CVE (HR: 2.66 IC (95%): 1.6-4.4 p< 0.001), but not with de novo tumors (p=0.94) nor early and late survival (p=0.58 and p=0.87). CONCLUSION: Pre-LT MS is increasing among LT candidates and is associated with a higher risk of post-LT morbidity CVE yet without affecting mortality. .

Physical frailty in liver transplantation.

In patients with cirrhosis, frailty represents a status of global physical dysfunction associated with a multiplicity of factors, including muscle wasting, undernutrition and malnutrition, and functional impairment. This condition is particularly prevalent among those with advanced cirrhosis, such as liver transplant (LT) candidates. Studies in this vulnerable population have demonstrated that its presence is independently predictive of adverse outcomes both pre- and post-transplantation, and thus that its incorporation into clinical practice could result in improved clinical decision-making, particularly regarding the identification of candidates for physical and nutritional interventions. There are, however, some limitations to its immediate incorporation into organ allocation prioritization models, including the wide heterogeneity of instruments used for measuring frailty, and particularly the lack of a single one suitable in all LT clinical scenarios (inpatient vs outpatient; pre- vs post-transplant). Finally, the data on the potential effects of frailty improvement on the diverse range of outcome measures are still preliminary.

[Pegylated-interferon alpha plus ribavirin-induced subacute thyroiditis in chronic hepatitis C]. / Tiroiditis subaguda inducida por el tratamiento con interferón alfa pegilado y ribavirina en un caso de hepatitis crónica por virus C.

Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin.

Tiroiditis subaguda inducida por el tratamiento con interferón alfa pegilado y ribavirina en un caso de hepatitis crónica por virus C / Pegylated-interferon alpha plus ribavirin-induced subacute thyroiditis in chronic hepatitis C

La infección crónica por el virus de la hepatitis C puede acompañarse de manifestaciones extrahepáticas. En especial se ha relacionado la enfermedad tiroidea con el tratamiento con interferón alfa. Se presenta el caso de una mujer de 40 años con infección por el virus de la hepatitis C, que desarrolló un cuadro de tiroiditis subaguda durante el tratamiento con interferón alfa pegilado y ribavirina (AU)

Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin (AU)