Metabolic syndrome before liver transplantation: does it have an impact on post-liver transplantation outcome?

Introduction: metabolic syndrome (MS) and cardiovascular risk factors are common in liver transplant (LT) candidates and recipients. Cardiovascular events and de novo tumors are increasingly common causes of mortality in liver transplant recipients. The aims of this study were i) to assess the prevalence of MS in LT recipients and its growth over the years, and ii) to determine if the presence of MS pre-LT is associated with a higher risk of post-LT cardiovascular events (CVE), de novo tumors, or early and late survival. Patients and methods: a retrospective study was performed that included LT recipients from January 2012 to December 2017. Baseline features (MS before LT and at 1year post-LT) and outcomes (CVE, de novo tumors and survival) were recorded. Results: a total of 483 recipients were included, MS was present in 20 % of pre-LT subjects with an increasing prevalence over time, from 16 % in 2012 to 34 % in 2017 (p = 0.025). One-year post-LT, an additional 12 % had developed de novo MS. At a median of 56 months of follow-up, 13 % developed a CVE and 9 % a de novo tumor. One and 5-year survival rates were 91 % and 83 % in those with pre-LT MS, and 93 % and 85 % in those without it (p = 0.94). The presence of MS before LT was independently associated with a higher risk of post-LT CVE (HR: 2.66, 95 % CI: 1.6-4.4, p < 0.001) but not with de novo tumors (p = 0.94) nor early and late survival (p = 0.58 and p = 0.87). Conclusion: pre-LT MS is increasing among LT candidates and is associated with a higher risk of post-LT morbidity (CVE) yet without affecting mortality. Keywords: Cardiovascular event. De novo tumors. Liver transplantation. Metabolic syndrome. Survival.