Leptin, Insulin Resistance, and Metabolic Changes 5 Years After Renal Transplantation

Objective To evaluate leptin, insulin resistance (IR), and changes in body composition and lipid profile within 5 years after renal transplantation. Design Longitudinal study. Setting Hospital de Clínicas de Porto Alegre/RS, Brazil. Subjects Thirty-two renal transplant recipients were followed up for 5 years after transplantation. Methods Data were collected at transplantation time (T1 ) and after 3 months (T2 ), 1 year (T3 ), and 5 years (T4 ). Leptin serum levels, IR assessed by homeostasis model assessment (HOMA) index, lipid profile, and anthropometric measurements were analyzed. Data were compared with a control group at baseline. Results At T1 , pretransplant patients had leptin levels (ng/mL) (11.9 [9.2 to 25.2]) higher than the control group (7.7 [5.2 to 9.9]; P < .0001). After transplantation, levels decreased at T2 and T3 , but increased at T4 to values similar to those seen at T1 (T4 : 9.2 [5.7 to 21]; P = 1). HOMA also decreased at T2 , but increased at T4 to identical levels (T1 : 2.1 [1.63 to 2.23], T4 : 2.1 [1.6 to 2.85]; P = 1). No significant changes in body fat percentage (BF%) were observed; however, the arm muscle circumference increased significantly at T4 ( P < .0001). At T2 , total cholesterol, triglycerides, and low-density lipoprotein cholesterol increased, whereas at T4 , lipid profile moved toward T1 levels. By linear regression analysis, gender, BF%, and HOMA were independent predictors of leptin levels. A trend toward higher body mass index was observed in woman who also presented higher leptin and lower HOMA levels. Conclusion Leptin levels and HOMA decrease in the immediate posttransplant period and remain reduced for at least 1 year. Five years post transplantation, leptin, IR, BF%, and lipids have a profile similar to those in the pretransplant period. This metabolic profile is possibly associated with the elevated incidence of cardiovascular diseases observed in the late posttransplant period.