The obesity problem and related factors after liver transplantation

Objective: Liver transplantation enables long-term survival for a large number of patients and therefore requires a long follow-up period. Weight gain and obesity are common health problems that can be seen in liver transplant recipients. Successful liver transplantation rate has increased in our country, providing a long term survival with immunosuppressive therapy administered. Long term survival carries a risk of new health problems such as obesity. Therefore, this study aims to investigate factors affecting the development of obesity after liver transplantation. So that medical measures against this problem will prevent the development of obesity and reduce the prevalance of it.Patients and Methods: In this study, medical records of 343 liver transplantation cases followed between January 2001 and January 2010 in Dokuz Eylul University Faculty of Medicine Hospital, Izmir, Turkey are retrospectively analysed. Liver transplant recipients who was older than 18 years of age and followed up for at least one year after transplantation are included in the study. Multiple organ transplantation (re-transplant or having both liver and kidney transplantation) patients are excluded from the study. Patients' age, gender, etiology of the disease, donor type, preoperative Child-Pugh score, MELD score, pre-liver transplant height, body weight, body mass index measurements, post-transplant first, sixth and 12th month to next 5 year follow up changes in body weight and body mass index measurements with records of corticosteroids and immunosuppressive therapies used are obtained from the medical records retrospectively. Intergroup analysis is done by using Student's t test, ANOVA test, Mann-Whitney U tests. Differences between the groups are compared using the Paired Samples T test. Parametric data, mean ± standard deviation, median non-parametric data (minimum-maximum) and categorical data are presented as percentage tabel. Results are considered statisticaly significant at p <0.05.Results: In this study, records of 343 liver transplant patients were reviewed retrospectively. 71 patients were followed for a period of less than one year, sufficient data of 19 patients could not be obtained, re-transplantation was made in 5 patients (10 liver transplant) and data of 17 patients who were under 18 years during liver transplantation was not included in the study. The medical records of the remaining 226 patients are included in the study. 151 patients (66.8%) were male and 75 were female (33.2 %), mean age was 46.19 ± 10.2 years. 123 of Liver transplantations were from living donors and 103 were cadaveric donors. According to retrospective data from 226 patients post-transplant mean BW was 66.4 ± 11.0 kg and mean BMI was 23.7±3.6 kg/m² . Mean BMI gradually increased during the follow up and reached up to 25.1 kg/m² and 26 kg/m² 6 months later and at the end of first year, respectively. Statistically significant increase in BMI is observed (p <0.002). The number of obese patients after transplantation was 29 (12.8 %) at 6th month follow up, 37 (16.3%) at the end of first year and 40 (21.0%) at the end of second year. Obesity developed in 18.2% of post-transplant patients who were receiving calcineurin inhibitor (CNI; tacrolimus (TAC), cyclosporine (CsA)). For the development of obesity after transplantation no statistically significant difference was found between patients using cyclosporine and tacrolimus, (p: 0.07). 164 of total 226 study patients (72.5%) received steroids for only six months and 49 (21.6%) received steroids for a year. Post transplant in sixth month the mean body weight gain in the group receiving steroids and not receiving steroids were 4.71 kg and 2.7 kg, respectively (p: 0.03). Before liver transplantion 41 patients (18.1%) had diabetes mellitus,15 patients (6.6%) had hypertension, 1 patient had hyperlipidemia. In the post-transplant period, there was no significant difference in patients who have received the TAC and CsA for the development of diabetes mellitus, hypertension and hyperlipidemia (p = 0.30).Conclusion: In our study of patients with liver transplantation, at the end of the second year the prevalance of obesity was 21.0%. Immunosuppressive drugs (such as CNI, mTOR inhibitors, MMF ) except corticosteroids had no significant effect on the development of weight gain and obesity. Thus, corticosteroid therapy used in the first months after transplantation, as well as many factors such as sedentary lifestyle, increased appetite and nutritional healing with improvement of hepatic function play a role in the development of weight gain and obesity. The important measures that avoiding the use of long-term steroid therapy and well-trained about obesity for the lack of increase in obesity after liver transplantationKey words: Liver transplant recipients, obesity, immunosuppressive treatment.