The impact of insulin resistance and NAFLD after liver transplantation on patient survival and development of chronic kidney disease

Czech version

Authors: Irena Míková ¹; D. Erhartová Kyselová ^1,2; K. Dvořáková ¹; M. Dezortová ³; M. Hájek ³; M. Cahová ⁴; H. Daňková ⁴; V. Lánská ⁵; Julius Špičák ¹; Pavel Trunečka ¹
Authors‘ workplace: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha ¹; Fyziologický ústav 1. LF UK, Praha ²; Pracoviště radiodiagnostiky a intervenční radiologie, Institut klinické a experimentální medicíny, Praha ³; Centrum experimentální medicíny, Institut klinické a experimentální medicíny, Praha ⁴; Oddělení datových analýz, statistik a umělé inteligence OI, Institut klinické a experimentální medicíny, Praha ⁵
Published in: Gastroent Hepatol 2022; 76(5): 429-441
Category: Hepatology: original article
doi: https://doi.org/10.48095/ccgh2022429

Overview

Introduction: Insulin resistance (IR) is a hallmark of non-alcoholic fatty liver disease (NAFLD), which has been associated with worse long-term survival and more frequent occurrence of chronic kidney disease (CKD) than in patients without NAFLD. The aim of our study was to evaluate the impact of NAFLD and IR on survival and renal function in patients after liver transplantation (LT). Methods: Our prospective study included 96 LT candidates who were observed after LT. We evaluated patient survival and occurrence of CKD (defined as estimated glomerular filtration [eGFR] ≤1.00 mL/s/1.73 m² or overt proteinuria) 5 years after LT and at the end of follow-up. Clinical, laboratory, MR and elastographic evaluation before and 1 year after LT were performed as well as liver biopsy 1 year after LT. Results: Of the factors present 1 year after LT, higher ALT (P = 0.021), ALP (P = 0.012) and everolimus treatment (P = 0.025) increased the risk of death at the end of follow-up, borderline significance was found also for higher waist circumference (P = 0.058), AST (P = 0.059), HOMA-IR (P = 0.056) and presence of fibrosis stage ≥3 in biopsy (P = 0.055). In addition to the presence of CKD 1 year after LT (P <0.001), other independent posttransplant risk factors of CKD 5 years after LT included presence of IR defined as HOMA-IR ≥3 (OR 4.33; 95% CI 1.25–15.04; P = 0.021) and higher serum high-molecular-weight (HMW) adiponectin (OR 1.25; 95% CI 1.03–1.50; P = 0.021). Of the factors present 1 year after LT, diabetes treated by antidiabetics (P = 0.008), higher serum levels od triglycerides (P = 0.031), C-peptide (P = 0.022) and leptin (P = 0.002) and lower total bilirubin (P = 0.006) were associated with lower eGFR at the end of follow-up. We observed a trend towards higher eGFR levels in patients treated with everolimus (P = 0.055). We did not observe an impact of grade of steatosis and presence of steatohepatitis on biopsy 1 year after LT on survival or renal functions. Conclusion: Presence of IR 1 year after LT independently increased the risk of CKD 5 year after LT. Patients with higher HOMA-IR 1 year after LT had a trend towards worse survival at the end of follow-up.

Keywords:

liver transplantation – non-alcoholic fatty liver disease – insulin resistance – chronic kidney disease – survival

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