Pre-liver transplant visceral adipose tissue predicts the early development of metabolic syndrome post-transplant

Background and Aims:Post liver transplantation metabolicsyndrome (PTMS) is a significant independent risk factor forcardiovascular disease. Risk factors for developing PTMS includepre-transplant diabetes, obesity and increasing age. Low muscle mass, excess adipose tissue, and poor cardiorespiratory fitness are risk factors for metabolic syndrome in the general population which have had limited evaluation post liver transplantation. Our aim was to assess the role of these variables in predicting the early development of PTMS. Method:A retrospective cohort study was performed by assessing consecutive adult patients for inclusion who received a liver transplant by the Queensland Liver Transplant Service between August 2012 and June 2016. We included seventy-seven patients for analysis. Demographic, anthropometric and metabolic data were collected pre-transplant and at 3 months post-transplant. Metabolic Syndrome was defined in accordance with international guidelines. Pre-transplant Computed Tomography (CT) skeletal muscle (SMA),visceral adipose (VAT) and subcutaneous adipose (SAT) areas were measured at the level of the 3rd Lumbar vertebrae using ImageJ software (NIH, Bethesda, MD, USA). Skeletal Muscle Index(SMI) was calculated by correcting the SMA for height, squared. Cardiorespiratory fitness [using the ventilatory threshold (VT)] was determined from a cardiopulmonary exercise test.Results:The median age was 56.0 years [interquartile range 51.0–59.0] with 58 (77%) males. Primary liver disease aetiology was hepatitis C (57%) followed by primary sclerosing cholangitis (13%)and alcohol (12%). Thirty patients (40%) had a diagnosis of hepatocellular carcinoma. Ten patients (13%) developed early onset PTMS by 3 months post-transplant. Patients who developed PTMS had higher pre-transplant body mass index (BMI) (p = 0.012),VAT (p = 0.001) and SAT (p = 0.008). There was no difference in VT(p = 0.772) or SMI (p = 0.313) between those who did or didn’t develop PTMS. Univariate logistic regression found that BMI (p =0.019), VAT (p = 0.004) and SAT (p = 0.01) were significant predictors for the development of PTMS. After multivariate analysis, only VAT remained a significant predictor (Odds ratio 1.02, 95%CI 1.00–1.04;p = 0.042). A sensitivity and specificity analysis determined that the optimal cut-off value for VAT predicting PTMS was >153.4cm2(Sensitivity 80%; Specificity 80%). Conclusion: Pre-transplant VAT is independently associated with the early development of PTMS. Body composition analysis using cross-sectional imaging prior to liver transplant can assist with risk stratification for PTMS. These patients could be targeted for interventions to prevent this, either pre- or early post-liver transplantation.