Reduced incidence of hyperuricemia, gout, and renal failure following liver transplantation in comparison to heart transplantation: a long-term follow-up study.
BACKGROUND
Hyperuricemia and gout are common complications of heart transplantation, reaching a prevalence of 84% and 30%, respectively, in heart transplant recipients. In contrast, they are seldom reported following orthotopic liver transplantation (OLT).


METHODS
We retrospectively evaluated 75 consecutive liver transplant recipients and 47 consecutive heart transplant recipients, followed for at least 3 years after transplantation in a single transplantation center in Jerusalem, Israel. Data was collected on demographic and clinical variables, levels of uric acid, the occurrence of gout, renal function, and variables effecting hyperuricemia, such as weight and medications.


RESULTS
Clinical gout was significantly more prevalent in heart recipients than in liver recipients (25.5% and 2.6%, respectively). Hyperuricemia was present in 100% of heart recipients, with an average uric acid level of 451 micromol/l, as compared with 85.7% and 403 micromol/l for liver recipients (P < 0.001 for both variables). Univariate analysis identified several parameters which significantly influenced the difference in hyperuricemia and gout among the two groups including age, gender, rejection episodes, hypertension, diabetes mellitus, the level of uric acid prior to transplantation, and the use of cyclosporine A, diuretics, steroids, and aspirin. Use of tacrolimus and azathioprine were associated with decreased incidence of hyperuricemia and gout. Multivariate analysis identified the type of transplantation as the only independent risk factor predicting the development of hyperuricemia and gout.


CONCLUSIONS
Clinical gout and hyperuricemia were significantly more prevalent in heart recipients than in liver recipients. The disparity can be explained by differences in age, gender and renal function among the groups, as well as by the use of different medication regimens.
Shibolet
Oren
O
Liver Unit, Department of Medicine, Hadassah University Hospital, PO Box 12000, Jerusalem 91120, Israel. shibolet@hadassah.org.il
Elinav
Eran
E
Ilan
Yaron
Y
Safadi
Rifaat
R
Ashur
Yaffa
Y
Eid
Ahmed
A
Zamir
Gideon
G
Fridlander
Michael
M
Bdolah-Abram
Tali
T
Shouval
Daniel
D
Admon
Dan
D
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000453:epidemiology*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D033461:Hyperuricemia / Q000453:epidemiology*; D015994:Incidence; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D051437:Renal Insufficiency / Q000453:epidemiology*