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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(4): 287–295. doi:10.14735/amgh2019287.

Evolution of insulin resistance after liver transplantation – a prospective study

Irena Míková1, Denisa Erhartová1, Kateřina Dvořáková1, Petr Šedivý2, Miloslav Drobný2, Monika Dezortová  2, Milan Hájek  2, Monika Cahová3, Helena Daňková3, Eva Sticová  4, Věra Lánská  5, Pavel Trunečka6

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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 defined 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.


NAFLD, insulin resistance, magnetic resonance, metabolic syndrome, liver transplantation

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