Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study

Table 2 Most used immunosuppressive drugs and main metabolic side effects

Factor	Metabolic consequences	Ref.
Steroid	Increased fat deposition with truncal fat distribution	[36,53-55]
	Decreased fat oxidation
	Increased gluconeogenesis
	Obesity
	Decreased glucose utilization
	Decreased b-cell insulin production
	Increased proteolysis,
	Reduced protein synthesis
	Insulin resistance
	Diabetes, NAFLD
	Mineralocorticoids effects
	Sodium retention
	Hypertension
	Hyperlipemia
Calcineurin inhibitor	Tacrolimus:	[58-65]
	b-cell toxicity
	Decreased insulin secretion
	Insulin resistance,
	Diabetes (more than cyclosporine)
	Cyclosporine:
	Decreased energy metabolism and muscle mass obesity
	Weight gain
	Decreased cholesterol transport into bile hyperlipidemia
	Occupy LDL receptor
	(more than tacrolimus)
	Renal vasoconstriction
	Hypertension
	(more than tacrolimus)
mTOR inhibitor	Increase insulin response	[68,125-129]
	Block b-cell proliferation
	Alter insulin signaling
	Decreased diabetes
	Increased diabetes
	Increased triglyceride production pathways
	And secretion
	Increased adipose tissue lipase activity
	Hyperlipidemia
	Decreased Lipoprotein lipase activity
Anti-metabolites	Mycophenolate mofetil:	[145-149]
	No nephrotoxity
	No effect on lipid profile, hypertention or diabetes mellitus
	Azatioprine:
	Vascular calcification
	Arteriosclerosis
Monoclonal antibodies	Basiliximab	[150]
	No nephrotoxity
	Rare effect on lipid profile, hypertension and diabetes mellitus