Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4920
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
Liver transplantation (LT) is still the standard treatment for patients with end-stage liver disease. The usage of livers from donation after cardiac death (DCD) donors has increased rapidly. Current research shows that some risks of a series of acute and chronic complications are correlated with the warm ischemia time (WIT). Thus, the long-term prognosis of DCD LT has gained increasing attention.
After LT, patients may develop a series of metabolic disorders which is called posttransplant metabolic syndrome (PTMS). However, data on specific assessment of the morbidity of PTMS after DCD LT are still lacking. Therefore, this study aimed to further explore the prevalence of PTMS after DCD LT and the pre- and postoperative risk factors, to provide evidence for clinical decision rules.
The present retrospective analysis describes the prevalence of PTMS after DCD LT and the pre- and postoperative risk factors that are relevant to the occurrence of PTMS, and provides evidence for clinical judgment.
This is a retrospective cohort study. One hundred and forty-seven subjects who underwent DCD liver transplantation from January 2012 to February 2016 were enrolled in this study. The pre- and post-transplantation demographics and clinical characteristics were collected for both recipients and donors. 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. All data were used to perform statistical analysis and identify the variables independently associated with PTMS in the final multivariate model.
In this retrospective cohort study, the prevalence of PTMS after DCD donor orthotopic LT was 13.6%. Recipient’s body mass index, WIT, and posttransplant hyperuricemia were significantly associated with PTMS. The change in serum uric acid level in PTMS patients was significantly higher than that in non-PTMS patients. After the 1st month, 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.
PTMS could occur at early stage after LT DCD with growing morbidity as time goes on. For the first time, we found that prolonged WIT and the posttransplant hyperuricemia were associated with the prevalence of PTMS, and an increased serum uric acid level was highly associated with PTMS and could serve as a serum marker for monitoring such a disease.
In this study, the ineluctable WIT rather than cold ischemia time for DCD LT was found initially as an independent risk factor of PTMS. Nonetheless, further experiments are essential for exploring the underlying mechanism. Our data also indicated that the increased serum uric acid level was highly associated with PTMS. Although prolonged WIT remains a potential cause for the tendency of a rapid rise in the level of serum uric acid in the perioperative period of LT, after a sharp increase in the first month, the level of uric acid stabilized in the non-PTMS cohort. However, it continued to increase in PTMS patients and overstepped the upper limit of normal blood uric acid concentration. Intriguingly, after adjusting for renal function, the disparity in the values persisted. Recently, accumulating evidence also suggests the standpoint that uric acid is an independent predictor of metabolic syndrome. In consideration of our research results, more prospective studies are urgently required to provide evidence for clinical verification. Future research should include larger cohorts of patients from multiple centers to expand the sample size and establish a more comprehensive long-term follow-up to improve the statistical database containing more factors, including PTMS and survival rate.