Abstract
Introduction: Insulin resistance (IR) plays an important role in the pathogenesis of nonalcoholic fatty liver disease and other diseases. Data regarding the prevalence and evolution of IR in patients before and after liver transplantation (LT) are limited.
This prospective study aimed to evaluate the prevalence and evolution of IR in patients before and within 2 years (Y) after LT. Methods: In 77 patients listed for LT from May 2015 to April 2017, clinical, laboratory, and elastographic evaluations were performed before LT and 6 months (M), 1Y, and 2Y after LT.
The liver fat content was also determined by 1H magnetic resonance (1H MR) spectroscopy. Liver graft biopsy was performed at 1Y and 2Y after LT.
Results: IR defi ned as HOMA-IR >= 3.0 was found in 26 patients (41.3%) before LT, 16 patients (25.4%) at 6M after LT, 22 patients (34.9%) at 1Y after LT, and 29 patients (46.0%) at 2Y after LT (P = 0.028 for 2Y vs. 6M). Pretransplant IR correlated with age, indication for LT, and the presence of metabolic syndrome.
IR at 2Y after LT correlated with the presence of metabolic syndrome, hypertension, and diabetes mellitus, body mass index, the level of gamma-glutamyl transferase , the liver fat content estimated both histologically and by 1H MR spectroscopy, the grade of ballooning in liver biopsy, and the fibrosis stage estimated by shear wave elastography. Conclusion: The prevalence of IR is high in patients both before and after LT, and increases significantly with time after LT.
Great attention should be paid to posttransplant IR and associated factors.