Post-liver transplant obesity and diabetes

Purpose of review Post-liver transplant patients present a vast array of metabolic changes in the early and late phase which impact on their morbidity and mortality. The development of obesity and diabetes in these patients has been widely described in the literature with several hypotheses suggested: liver donor, nutritional and metabolic state, and immunosuppressive drugs. Recent findings Most that is known about the development of these metabolic derangements has been attributed to the drugs used, especially the corticosteroids. When these have been used in higher doses for longer periods to treat rejection, the incidence of diabetes and obesity seems to be higher. However cyclosporine and to a lesser extent tacrolimus are also related to these alterations. Summary As long-term survival improves in liver transplant patients, cardiovascular complications associated with dyslipidemia, obesity, and diabetes are emerging as risk factors for late morbidity and mortality. Therefore, it is important to assess the potential risk factors related to these complications, in order to prevent or decrease their incidence. From what has been seen, immunossupressive drugs seem to be the greatest risk factor for the development of metabolic derangements in post-transplantation patients. However other risk factors might also be involved, such as non-healthy eating habits and lack of exercise. The latter can be preventable if counseling policies are targeted at these patients in the pre-transplantation phase and continued after the operation.