engleski

Metabolic changes in early post-liver transplant settings: Is there a difference in insulin resistance, adiponectin and leptin levels between cirrhotic patients transplanted for viral hepatitis C compared to other etiologies?

INTRODUCTION AND AIMS: Both liver cirrhosis and chronic hepatitis C virus (HCV) infection are considered to cause metabolic disarrangements resulting in increased insulin resistance, possibly by means of disturbance of adipocytokine levels. Improvements of metabolic status following liver transplantation (LT) have been reported by various authors. However, long-term outcomes of transplanted patients are worsened by the occurrence of metabolic syndrome or its components, leading to an increased cardiovascular morbidity and mortality. It is reasonable to postulate that different metabolic changes occur at different time-points following LT. The aim of this study was to evaluate metabolic markers such as insulin resistance (IR), and adipocytokines adiponectin (AND) and leptin (LPN) early post-LT, and to investigate their patterns in HCV+ patients vs. other etiologies. METHODS: Serum samples were obtained from sixty- four patients (43 male) pre- and 3 months post LT. The predominant etiology included alcoholic cirrhosis (61%), followed by HCVG1+ cirrhosis (23, 4%). No patients with non-alcoholic steatohepatitis were included. IR was assessed by the Homeostasis Model Assessment 2 (HOMA-2) model and ADN and LPN concentrations were determined by validated enzyme-immunoassay methods. Statistical analysis was conducted by IBM SPSS Statistics 23 software. RESULTS: A significant decrease of early post-LT IR was noted, with pre-transplant values of 3, 83 ; CI 2, 86-4, 79, dropping to 1, 92 ; CI 1, 51-2, 24 following LT (p=0, 00). The mean baseline ADN levels (20, 53 mg/L ; CI 17, 94-23, 12) and LPN levels (14, 25 ug/L ; CI 11, 05-17, 46) decreased significantly following LT (p=0, 00 ; p=0, 012) in the whole cohort. Subanalysis of the HCV+ group revealed only a significant ADN level decrease with a preoperative mean of 22, 76 mg/L dropping to 14, 49 postoperatively (p=0, 003) while IR and LPN levels decreased but without reaching statistical significance. No differences were noted in AND/LPN between HCV+ and HCV- patients both pre- and post-operatively. CONCLUSIONS: Our results show a paradoxical decrease in insulin-sensitising adipocytokines ADN and LPN in the context of IR amelioration. This effect could possibly be explained by external factors such as steroid use in the first weeks following LT. Further on, a less favourable metabolic pattern for HCV+ patients was observed with persisting levels of IR post-LT.

ADIPONECTIN, LEPTIN, INSULIN RESISTANCE, LIVER TRANSPLANTATION, CHRONIC HEPATITIS C

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