Association Of Graft And Renal Function With Post-transplant Hyperlipidemia In Living Donor Liver Transplantation: Hangzhou Experience

Background/Aims:Post-transplant hyperlipidemia (PTHL) is one of the major and serious complications after liver transplantation (LT). Living donor liver transplantation (LDLT) is becoming an essential alternative to cadaveric donor liver transplantation (CDLT) due to the shortage of liver donor pool over the past years. Kidney and liver were well demonstrated to be two critical organs associated with body lipid metabolism, whose dysfunction could lead to hyperlipidemia. In this study, we aim to assess the prevalence and risk factors for PTHL in LDLT recipients and identify the relation between peri-transplant kidney/liver function and lipid metabolism. Methods:115adult patients who underwent LDLT from January2007to May2009and survived more than6months were enrolled. Post-transplant hyperlipidemia was defined as serum triglycerides≥150mg/dL or serum cholesterol≥200mg/dL or pharmacologic treatment at the post-transplant month3. The clinic data of patients with PTHL (PTHL group) and without PTHL (Non-PTHL group) were compared. Variables with statistical significance were taken for a multivariate logistic regression analysis and correlation analysis.Results:Of all the115eligible patients,28patients (24.3%) developed PTHL. Donor’s and recipient’s pre-transplant hyperlipidemia was not significantly associated with the development of PTHL. The1-year and3-year cumulative survival rates were89.3%and85.7%in PTHL group,97.7%and85.0%in non-PTHL group, respectively, with no significant difference. Compared to the Non-PTHL group, PTHL group showed remarkably higher pre-transplant BMI (P=0.036), pre-transplant serum creatinine level (P=0.020) and incidence of post-transplant cardiovascular events (P=0.037) and significantly lower GR/WR (P=0.048), GV/SLV (P=0.011) and pre-transplant GFR (P=0.008). By univariate analysis, pre-transplant creatinine level and GFR, BMI, GR/WR, GV/SLV, ERD, EAD (P=0.002-0.036, OR=2.667-9.333) were significant predictors for PTHL. Among these, BMI (P=0.002, OR=6.358) and ERD (P=0.000, OR=9.593) were significantly independent risk factors for PTHL by multivariate analysis. Recipients with ERD showed significantly worse renal function and higher incidence of TG and PTHL than those without ERD. Post-transplant GFR and serum creatinine level showed a significantly negative correlation and positive correlation with serum total triglyceride level, respectively, at post-transplant month1and month3. Of all the LDLT recipients,80(69.6%) recipients’liver function recovered smoothly to normal level within post-transplant month3. Serum total cholesterol level showed a significantly positive correlation with cholinesterase level at post-transplant month1and month3.Conclusion:PTHL is a very common complication in LDLT. Recipient’s BMI and presence of ERD independently determine the development of PTHL. Chronic renal dysfunction before LDLT will increase the incidence of ERD which will result in PTHL eventually. Protecting and improving renal function during both pre-and post-LDLT period is very important.