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World J Gastroenterol. Jul 21, 2020; 26(27): 3851-3864
Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3851
Expert consensus on management of metabolic disease in Chinese liver transplant recipients
Tian Shen, Li Zhuang, Xiao-Dong Sun, Xiao-Sheng Qi, Zhi-Hui Wang, Rui-Dong Li, Wen-Xiu Chang, Jia-Yin Yang, Yang Yang, Shu-Sen Zheng, Xiao Xu
Tian Shen, Shu-Sen Zheng, Xiao Xu, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Li Zhuang, Shu-Sen Zheng, Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310003, Zhejiang Province, China
Xiao-Dong Sun, Department of Hepatobiliary and Pancreas Surgery, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
Xiao-Sheng Qi, Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
Zhi-Hui Wang, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Rui-Dong Li, Department of General Surgery and Liver Transplant Center, Huashan Hospital, Fudan University, Shanghai 200040, China
Wen-Xiu Chang, Department of Nephrology, Tianjin First Center Hospital, Tianjin 300384, China
Jia-Yin Yang, Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Yang Yang, Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Shen T designed the primary structure of this consensus with the help of Zhuang L, under the supervision of Zheng SS and Xu X; this paper was mainly written by Zhuang L and Shen T, with the contribution of Sun XD, Qi XS, Wang ZH, Li RD, Chang WX, Yang JY, and Yang Y.
Supported by the National Science and Technology Major Project of China, No. 2017ZX10203205; National Natural Science Funds for Distinguished Young Scholar of China, No. 81625003; National Natural Science Foundation of China, No. 81930016.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Xiao Xu, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zjxu@zju.edu.cn
Received: March 15, 2020
Peer-review started: March 15, 2020
First decision: April 8, 2020
Revised: April 28, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 21, 2020
Abstract

Metabolic disease, including diabetes mellitus, hypertension, dyslipidemia, obesity, and hyperuricemia, is a common complication after liver transplantation and a risk factor for cardiovascular disease and death. The development of metabolic disease is closely related to the side effects of immunosuppressants. Therefore, optimization of the immunosuppressive regimen is very important for the prevention and treatment of metabolic disease. The Chinese Society of Organ Transplantation has developed an expert consensus on the management of metabolic diseases in Chinese liver transplant recipients based on recent studies. Emphasis is placed on the risk factors of metabolic diseases, the effect of immunosuppressants on metabolic disease, and the prevention and treatment of metabolic diseases.

Keywords: Liver transplantation, Metabolic disease, Diabetes mellitus, Hypertension, Dyslipidemia, Hyperuricemia, Obesity, Immunosuppressive agents, Consensus

Core tip: This consensus aims to provide recommendations for the prophylaxis and treatment of metabolic disease in Chinese liver transplant recipients to improve the long-term survival of the recipients. The principles of prophylaxis and treatment include lifestyle modification, individualization of immunosuppressive regimen, and drug therapy. In addition to the contents related to diabetes mellitus, hypertension, and dyslipidemia, this edition of consensus also includes the related contents of hyperuricemia and obesity, aiming at guiding the standardized management of metabolic disease in a more comprehensive way.