Recurrence of insulin resistant metabolic syndrome following liver transplantation

• Published in: European journal of gastroenterology & hepatology Vol. 15; no. 1; pp. 99 - 102
• Main Authors: Angelico, Francesco, Del Ben, Maria, Francioso, Simona, Hurtova, Monika, Battista, Serena, Palmieri, Gian Piero, Tisone, Giuseppe, Angelico, Mario
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-01-2003; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Digestive system; Fatty Liver - pathology; Female; Follow-Up Studies; Humans; Insulin Resistance; Investigative techniques, diagnostic techniques (general aspects); Liver Failure - surgery; Liver Transplantation; Medical sciences; Metabolic diseases; Metabolic Syndrome - diagnosis; Metabolic Syndrome - surgery; Middle Aged; Miscellaneous; Other metabolic disorders; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Recurrence; Recurrence; Pancreatic hormone; Prevalence; Liver; Cardiovascular disease; Transplantation; cardiovascular risk factors; Homotransplantation; Protein hormone; Hypoglycemic agent; cryptogenic cirrhosis; Association; Histopathology; X Syndrome; Heart disease; Surgery; Complication; Female; Hyperlipemia; Human; Etiopathogenesis; Metabolic diseases; Insulin; liver transplantation. non-alcoholic steatohepatitis; Case study; Resistance; metabolic syndrome; Pathology; Digestive diseases; Elderly
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/00042737-200301000-00018

Insulin resistant metabolic syndrome is a major clinical disorder including hyperlipidaemia, hypertension, impaired glucose tolerance and/or type 2 diabetes and central obesity, which are well established cardiovascular risk factors. We report the case of a 61-year-old woman who developed severe hypercholesterolaemia and hypertriglyceridaemia after liver transplantation. In her forties she had hypertension, mixed hyperlipidaemia, mild hyperglycaemia and moderate abdominal obesity, suggesting the presence of the metabolic syndrome. She had liver enzyme elevation and severe steatosis and hepatomegaly at ultrasonography. At age 52, cryptogenic liver cirrhosis was diagnosed and rapidly progressing liver failure developed. In 1992 she underwent liver transplantation. Seven years after transplant the patient had abdominal obesity, high blood pressure, marked hypercholesterolaemia, hypertriglyceridaemia and moderate elevation of alanine aminotransferase. She also had impaired glucose tolerance and markedly increased basal and post-glucose load plasma insulin levels. Steato-hepatitis was demonstrated by serial liver biopsies. This is the first case that reports the recurrence of the metabolic syndrome following liver transplantation. We postulate that metabolic syndrome may have promoted fatty liver and subsequent progression to end stage liver disease. We also stress the need for careful management of the metabolic syndrome in order to decrease the long-term risk for cardiovascular disease.