Recurrence of insulin resistant metabolic syndrome following liver transplantation.
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. Steatohepatitis 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.
Angelico
Francesco
F
Department of Clinical and Applied Medical Therapy, University of Rome La Sapienza, Italy. Francesco.angelico@uniroma1.it
Del Ben
Maria
M
Francioso
Simona
S
Hurtova
Monika
M
Battista
Serena
S
Palmieri
Gian Piero
GP
Tisone
Giuseppe
G
Angelico
Mario
M
D005234:Fatty Liver / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D012008:Recurrence