New-onset Metabolism Complications After Liver Transplantation:an Analysis On Risk Factors And Patient Survival

AIM:To retrospectively study the case data of liver transplantation and analyze the risk factors of new onset metabolic complications after liver transplantation and the impact on the prognosis of transplant recipients.METHOD:The medical records of recipients who underwent orthotopic liver transplantation in Shanghai General Hospital from July 2007 to September 2014 were collected.Exclusion criteria:1)cases younger than 18 years old;2)Death cases within1 month after surgery;3)multiple organ transplantation;4)cases of hypertension,diabetes and hyperlipidemia coexist before transplantation;5)Incomplete patient data.A total of 178 transplant recipients were collected.The definitions of hypertension,diabetes and hyperlipidemia are all defined in the relevant guidelines issued by the Chinese Medical Association.RESULTS:In the multivariate regression model of risk factors for new hypertension after liver transplantation,preoperative BMI>25 kg/m~2(p=0.006,OR=5.238,95%CI:1.592-17.239)was statistically significant;in the multivariate regression model of risk factors for new-onset diabetes after liver transplantation,the preoperative Child-Pugh grade C(p<0.001,OR=11.996,95%:3.340-43.089)and postoperative blood concerntrations of tacrolimus in the first month(p=0.013,OR=1.306,95%CI:1.058-1.612)were statistically significant;in the multivariate regression model of risk factors for new-onset hyperlipidemia after liver transplantation,age>60 years at the time of transplantation(p=0.035,OR=3.808,95%CI:1.095-13.241)was statistical significance.Survival analysis results showed that there was a statistically significant difference in the cumulative survival rate between the new-onset and non-diabetes groups during the follow-up period(p=0.001),and the survival rate was significantly lower in the new-onset diabetes group.There was no significant difference in cumulative survival between the new onset hypertensive group and the non-hypertensive group(p=0.875),neither was the difference in cumulative survival between the new hyperlipidemia group and the non-hyperlipidemia group(p=0.26).Correlation analysis shows the associations between acute and chronic renal insufficiency after transplantation and new onset hypertension after liver transplantation(p=0.003,OR=13.068,95%CI:2.382-71.683),and new-onset diabetes(p=0.024,OR=7.448,95%CI:1.299-42.698)were statistically significant.CONCLUSION:Preoperative BMI>25kg/m~2 is an independent risk factor for new onset hypertension after liver transplantation.Transplant recipients before surgery,Child-Pugh grade C and blood concentrations of tacrolimus among the first month after liver transplantation were the independent risk factors for new-onset diabetes after liver transplantation.The age>60 years at the time of transplantation was an independent risk factor for new onset hyperlipidemia.New onset diabetes after liver transplantation significantly reduced the cumulative survival rate of the recipient;new onset hypertensive and new-onset diabetes after transplantation may increase acute and chronic renal insufficiency.