New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore

The aims of this study were to establish weight change, incidence of non-alcoholic fattyliver disease (NAFLD) and cardiovascular risk factors (CvRF) in liver transplant recipients (LTRs).Methods: Eighty-three patients whose mean (standard deviation [SD]) age was 55.6 (8.4) years(median follow-up 73 months) and who underwent their first liver transplantation (LT) at SingaporeGeneral Hospital between February 2006 and March 2017 were included in the study. Anthropometric,clinical and demographic data were collected retrospectively from patients’ medical records. Diabetesmellitus (DM), hyperlipidaemia and hypertension were regarded as CvRF.Results: Compared to baseline, mean (SD) body weight decreased significantly at 1 month post-LT(60.8kg [11.9] versus 64.3kg [13.7], P<0.001). There was a gradual recovery of body weight thereafter,increasing significantly at year 2 (64.3kg [12.3] vs 61.5kg [13.7], P<0.001) until year 5 (66.9kg [12.4]vs 62.2kg [13.9], P<0.001), respectively. The prevalence of CvRF was significantly higher post-LT.NAFLD occurred in 25.3% of LTRs and it was significantly associated with post-LT DM andhyperlipidaemia.Conclusion: CvRF increased significantly post-LT, and NAFLD occurred in 25.3% of LTRs. Bodyweight dropped drastically within the first month post-LT, which then returned to baseline leveljust before the end of first year. This novel finding suggests that nutritional intervention needs to betailored and individualised, based on events and time from transplant. Although long-term obesity isa significant problem, aggressive oral or enteral nutritional supplements take precedence in the earlyand immediate post-LT period, while interventions targeted at metabolic syndrome become necessaryafter the first year.Keywords: Liver transplantation, cardiovascular risk factors, non-alcoholic fatty liver disease, obesity,weight change