Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2018; 24(43): 4920-4927
Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4920
Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death
Liang-Shuo Hu, Yi-Chao Chai, Jie Zheng, Jian-Hua Shi, Chun Zhang, Min Tian, Yi Lv, Bo Wang, Ai Jia
Liang-Shuo Hu, Yi-Chao Chai, Jian-Hua Shi, Chun Zhang, Min Tian, Yi Lv, Bo Wang, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jie Zheng, Clinical Research Center, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Ai Jia, Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Hu LS and Chai YC contribute equally to this work. This clinical research was conceived and designed by Jia A and Wang B, who acted co-corresponding authors. The data was collected by Shi JH, Zhang C, and Tian M. Zheng J provided statistical analysis. Interpretation of the data was performed by Hu LS and Chai YC, who also wrote the paper. Critical revision of the article was executed by Lv Y, Wang B, and Jia A. All authors participated in the revision of the manuscript. All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation, No. 81270521 (to Wang B. bobwang75@126.com).
Institutional review board statement: The clinical trial of this paper was reviewed and approved by the Committee of Medical Ethics of First Affiliated Hospital of Xi’an Jiaotong University (No. XJTU1AF2018LSK-084).
Informed consent statement: The form of consent to data acquisition was signed by patients or their guardian.
Conflict-of-interest statement: The authors report no conflicts of interest in this work.
Data sharing statement: All datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ai Jia, MD, Research Associate, Internist, Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, China. jiaai0129@163.com
Telephone: +86-29-85323927 Fax: +86-29-85323902
Received: September 3, 2018
Peer-review started: September 3, 2018
First decision: October 8, 2018
Revised: October 15, 2018
Accepted: November 8, 2018
Article in press: November 8, 2018
Published online: November 21, 2018
Abstract
AIM

To describe the prevalence of posttransplant metabolic syndrome (PTMS) after donation after cardiac death (DCD) liver transplantation (LT) and the pre- and postoperative risk factors.

METHODS

One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre- and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-III criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.

RESULTS

The prevalence of PTMS after DCD donor orthotopic LT was 20/147 (13.6%). Recipient’s body mass index (P = 0.024), warm ischemia time (WIT) (P = 0.045), and posttransplant hyperuricemia (P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients (P < 0.001). After the 1st mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.

CONCLUSION

PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

Keywords: Posttransplant metabolic syndrome, Liver transplantation, Donation after cardiac death, Uric acid, Warm ischemia time

Core tip: The objective of the current retrospective analysis was to describe the pre- and postoperative risk factors for prevalence of posttransplant metabolic syndrome (PTMS) after liver transplantation (LT) with donation after cardiac death (DCD). PTMS could occur at early stage after DCD LT with growing morbidity as time goes on. The warm ischemia time and posttransplant hyperuricemia were associated with the prevalence of PTMS. An increased serum uric acid level was highly relevant to PTMS and could act as a serum marker in this disease.