Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death

Abstract

Aim: To describe the prevalence of posttransplant metabolic syndrome (PTMS) after donation after cardiac death (DCD) liver transplantation (LT) and the pre- and postoperative risk factors.

Methods: One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre- and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-III criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.

Results: The prevalence of PTMS after DCD donor orthotopic LT was 20/147 (13.6%). Recipient's body mass index (P = 0.024), warm ischemia time (WIT) (P = 0.045), and posttransplant hyperuricemia (P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients (P < 0.001). After the 1^st mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.

Conclusion: PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

Keywords: Donation after cardiac death; Liver transplantation; Posttransplant metabolic syndrome; Uric acid; Warm ischemia time.

Figure 1

Posttransplant levels of serum uric acid in patients with and without posttransplant metabolic syndrome. The red folding line reflects the serum uric acid level change of patients who did develop posttransplant metabolic syndrome (PTMS) [data are presented as mean ± standard error of mean (SEM), and n = 20], and the azure folding line reflects the situation of patients without PTMS (data are presented as mean ± SEM, and n = 127). The abscissa in the figure indicates the period from pre-liver transplantation to post-liver transplantation 24^th mo. PTMS: Posttransplant metabolic syndrome; Post-LT: Post-liver transplantation.