engleski

LIVER TRANSPLANTATION AMELIORATES ADIPONECTIN DISTURBANCES IN ALCOHOLIC LIVER CIRRHOSIS

Background: Adiponectin (ADN), the most abundant adipose-specific secretory protein, exhibits insulin-sensitizing properties and is thus inversely correlated with diabetes and metabolic syndrome. Paradoxically, patients with liver cirrhosis, an insulin resistant state by itself, are observed to have aberrant ADN serum levels, not associated with parameters of body composition, free fatty acids or insulin levels. The aim of this study was to explore the dynamics of standard metabolic parameters and ADN serum levels before and after liver transplantation (LT) for alcoholic liver disease (ALD). Methods: A total of 29 consecutive ALD adult patients (mean age57.447.98 years, 79.3% male) were included. Patients with overt diabetes prior to LT were excluded. Parameters (body mass index (BMI), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), insulin sensitivity, insulin resistance (IR), lipid profile) were evaluated at 3-time points (prior LT, 3- and 6-months post LT). IR was assessed by the Homeostasis Model Assessment 2(HOMA-2) model and ADN concentrations were determined by validated enzyme-immunoassay methods. Results: LT induced significant metabolic changes, with an increase of FBG, HbA1c, insulin sensitivity, triglyceride and cholesterol levels (p=0.018 ; p<0.001 ; p=0.009 ; p<0.001 ; p<0.001, respectively), while a decrease of c- peptide and insulin levels, beta cell function, IR, and ADN was noted(p=0.045 ; p=0.001 ; p<0.001 ; p=0.002 ; p=0.001, respectively). BMI was unaffected during the follow-up and no significant metabolic changes were observed between 3 and 6 months post LT. Conclusions: LT elicited the reduction of IR with probable consequent alleviation of beta-cell function and insulin levels. Levels of ADN also decreased, possibly reflecting re-establishment of adipocytokine homeostasis significantly affected by cirrhosis. Further studies are needed to elucidate the complex interplay of adiponectin and metabolic alterations after LT.

LIVER CIRRHOSIS ; LIVER TRANSPLANTATION ; INSULIN RESISTANCE ; ADIPONECTIN

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