Post-transplant Metabolic Syndrome (PTMS) after Liver Transplantation –Review of the Literature

Liver transplant provides a definitive therapeutic measure for patients with chronic and acute liver diseases. Apart from the improvement of overall health, an organ transplant entails several metabolic complications. They are multi-agent and depend, among others, on the function of organ being transplanted, adverse effects of immunosuppression being applied, organ complications induced by failure of the organ being transplanted, current treatment, concomitant diseases and consequences of the acute and chronic rejection processes. Improvements in surgical techniques, peritransplant intensive care, and immunosuppressive regimens have resulted in significant improvements in short-term survival. Focus has now shifted to address long-term outcomes of liver transplantation. Therefore, this paper presents the current review of literature referring to specificity of the prevalence of metabolic syndrome and its complications in patients after liver transplantation

A common variant in the hepatobiliary phospholipid transporter ABCB4 modulates liver injury in PBC but not in PSC : prospective analysis in 867 patients

Background: The ATP-binding cassette subfamily B member 4 (ABCB4) gene encodes the hepatic phospholipid transporter. Variants in the ABCB4 gene are associated with various cholestatic phenotypes, some of which progress to liver fbrosis and cirrhosis. The aim of our study was to investigate the role of the cholestasis-associated variant ABCB4 c.711A>T (p.I237I, rs2109505) in patients with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Results: Two cohorts of Polish patients took part in this study. The Szczecin cohort comprised 196 patients with PBC (174 females, 38% with cirrhosis) and 135 patients with PSC (39 females, 39% with cirrhosis). The Warsaw cohort consisted of 260 patients with PBC (241 females, 44% with cirrhosis) and 276 patients with PSC (97 females, 33% with cirrhosis). Two control cohorts—150 healthy blood donors and 318 patients without liver disease, were recruited in Szczecin and in Warsaw, respectively. The ABCB4 c.711A>T polymorphism was genotyped using TaqMan assay. In both PBC cohorts, carriers of the risk variant presented more frequently with cirrhosis (Szczecin: OR=1.841, P=0.025; Warsaw: OR=1.528, P=0.039). The risk allele was associated with increased serum AST, GGT and ALP (all P<0.05) at inclusion. During the follow-up, patients in both cohorts signifcantly improved their laboratory results, independently of their ABCB4 c.711A>T genotype (P>0.05). During 8±4 years follow-up, a total of 22 patients in the Szczecin PBC group developed cirrhosis, and this risk was higher among carriers of the risk variant (OR=5.65, P=0.04). In contrast to PBC, we did not detect any association of ABCB4 c.711A>T with a liver phenotype in PSC cohorts. Conclusions: The frequent pro-cholestatic variant ABCB4 c.711A>T modulates liver injury in PBC, but not in PSC. In particular, carriers of the major allele are at increased risk of progressive liver scarring

Vitamin D Receptor Polymorphisms Predispose to Primary Biliary Cirrhosis and Severity of the Disease in Polish Population

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver condition characterized by the immune-mediated damage of the intrahepatic bile ducts. Polymorphisms of vitamin D receptor (VDR) are considered to contribute to its pathogenesis however their incidence varies in different populations and their potential association with the course of the disease has not been studied. In this paper we investigated the incidence and correlation of three VDR polymorphisms (BsmI, ApaI or TaqI) with various clinical, biochemical, and serological factors in a homogenous group of 143 Caucasian patients with PBC. Control group comprises 306 DNA samples from umbilical cord blood of healthy newborn children. When compared to controls, we observed a significant dominance of the b allele in the BsmI (OR = 1.69 [1.27–2.24]; P = 0.0003) and t allele in the TaqI (OR = 0.62 [0.47–0.82], P = 0.0001) in patients with PBC. Moreover the BsmI and TaqI polymorphisms were associated with the presence of advanced fibrosis/liver cirrhosis at the diagnosis of PBC. Pairwise linkage disequilibrium (LD) calculations proved that the analyzed SNPs are within an LD block (100% of LDs were D'>0.9). Our study showed, for the first time, that the analyzed polymorphisms of VRD may exert an effect on a natural history of PBC

TRAF1-C5

Background. Previous studies reported associations between specific alleles of non-HLA immunoregulatory genes and higher fatigue scores in patients with primary biliary cirrhosis (PBC). Aim. To study the relationship between variables of health-related quality of life (HRQoL) and single nucleotide polymorphisms of TRAF1-C5, a member of the tumor necrosis factor receptor family. Patients and Methods. TRAF1-C5 gene polymorphisms, rs2900180 and rs3761847, were analysed in 120 Caucasian PBCs. The HRQoL was assessed with SF-36, PBC-40, and PBC-27 questionnaires. Results. We found a negative association between TT genotype of rs2900180 and SF-36’s domains vitality (P<0.05), mental health (P<0.05), and mental component summary score (P<0.05). GG homozygotes of rs3761847 had lower vitality (P<0.05), mental health (P<0.05), mental component summary score (P<0.05) and impairment of social functioning (P<0.01). Allelic analysis has shown that T allele of rs2900180 and G allele of rs3761847 related to SF-36’s vitality (P<0.05 and P<0.01), social functioning (P<0.05 and P<0.05), mental health (P<0.01 and P<0.05), and mental component summary score (P<0.01 and P<0.05), respectively. Genotyping and allelic analysis did not reveal correlation with PBC-40 and PBC-27 domains. Conclusion. The association between rs2900180 and rs3761847 polymorphisms and HRQoL variables indicates that TRAF1 is involved in the induction of impaired QoL in PBC

Cirrhotic cardiomyopathy and hepatopulmonary syndrome in patient assessed prior to liver transplantation

Kardiomiopatia wątrobowa (CCM) i zespół wątrobowo-płucny (HPS) stanowią kliniczną manifestację zaburzeń w układzie krążenia w przebiegu nadciśnienia wrotnego. U pacjentów z marskością wątroby jedynym skutecznym leczeniem przyczynowym tych narządowych powikłań jest transplantacja wątroby. W artykule przedstawiono przypadek 47-letniego mężczyzny z pierwotnym stwardniającym zapaleniem dróg żółciowych, u którego w trakcie procesu kwalifikacji do transplantacji wątroby stwierdzono CCM oraz HPS. Istotność kliniczną patologii układu krążenia rozpoznano na podstawie sercowo-płucnego testu wysiłkowego, jednak — mimo podwyższonego ryzyka operacyjnego — transplantacja wątroby przebiegła pomyślnie.Cirrhotic cardiomyopathy (CCM) and hepatopulmonary syndrome (HPS) comprise clinical manifestation of cardiovascular dysfunction associated with portal hypertension. In patients with liver cirrhosis, the only effective treatment for this organ complication is liver transplantation. In this article we present a case of 47-year-old man with primary sclerosing cholangitis, developing CCM and HPS diagnosed during pretransplant evaluation. Clinical relevance of cardiovascular dysfunction was assessed in cardio-pulmonary exercise test. Despite of increased risk for major perioperative cardiovascular complications, liver transplantation was performed successfully

Znaczenie przetrwałego otworu owalnego u pacjenta kwalifikowanego do zabiegu ortotopowego przeszczepienia wątroby

Persistent foramen ovale (PFO) is a congenital defect of interatrial septum, that in majority of patients stays asymptomatic. However, in conditions that lead to increased pressure in right atrium over left atrium, it may lead to blood shunt from the right to the left atrium. We are presenting a case report of 63-years-old male who was referred to the qualification for the orthotopic liver transplantation due to the decompensated liver cirrhosis. During transesophageal echocardiography with contrast PFO was detected. In the literature cases suggesting increased perioperative risk in patients with PFO are described. It is both related to air embolisms connected with the transplantation itself and possibility of crossed embolisms. For this reason, the patient was scheduled to the transcatheter PFO closure, after which he could have liver transplantation. The operation was performed a month later, uneventfully.Przetrwały otwór owalny (PFO) to wrodzona wada przegrody międzyprzedsionkowej, która w większości przypadków nie ujawnia się klinicznie. Jednak w warunkach doprowadzających do przewyższenia wartości ciśnienia w prawym przedsionku nad lewym przedsionkiem może stanowić przyczynę przecieku prawo-lewego. W artykule przedstawiono przypadek 63-letniego mężczyzny ze schyłkową niewydolnością wątroby marskiej, kwalifikowanego do zabiegu ortotopowego przeszczepienia wątroby. U pacjenta podczas przezprzełykowego badania echokardiograficznego z użyciem kontrastu stwierdzono PFO. W literaturze istnieją opisy przypadków sugerujące podwyższone ryzyko okołooperacyjne w grupie pacjentów z PFO, które ma wynikać z ryzyka powstawania zatorów powietrznych podczas transplantacji wątroby, jak i, dodatkowo, z możliwości powstania zatorów skrzyżowanych przez PFO. Z tego powodu podjęto decyzję o przezskórnym zamknięciu PFO przed planowanym przeszczepieniem. Po wykonanym zabiegu pacjenta zakwalifikowano do operacji transplantacji wątroby, która odbyła bez powikłań, miesiąc po zamknięciu ubytku

Reduction of sitting time has a positive effect on the decrease of insulin resistance in patients with non-alcoholic fatty liver disease

Abstract Introduction: Non-alcoholic fatty liver disease (NAFLD) affects a large part of the human population. One of the major environmental factors associated with the risk of NAFLD is the lack of physical activity. Aim: To compare the level of physical activity and the insulin resistance in NAFLD patients. Material and methods: Thirty patients with NAFLD underwent a six-month dietary intervention based on the principles of classical dietetics. Data about diet and physical activity was based on 72-hour nutrition diaries and International Physical Activity Questionnaire (IPAQ). Standard blood biochemical analyses were carried out before and after diet at the University Hospital Laboratory. Results: The study showed that total physical activity and physical activity in leisure time are negatively correlated with insulin resistance (HOMA-IR) (p &lt; 0.05). Insulin (p &lt; 0.05), body weight (p &lt; 0.05), and waist-hip ratio (WHR) (p &lt; 0.05) were also negatively correlated with physical activity in free time. In addition, we noticed a positive correlation between sitting time and the risk of insulin resistance, in the case of HOMA-IR and insulin concentration (p &lt; 0.05). Conclusions: Dietary intervention and a physical activity plan are important factors in the treatment of non-alcoholic fatty liver disease. Taking regular exercise increases insulin sensitivity and prevents further development of the disease. It seems that diet and physical activity are not the only one risk factors of NAFLD. Our study reveals that the reduction of sitting time has a positive effect on the level of insulin and it reduces insulin resistance in patients with NAFLD