Prevalência da doença hepática esteatótica metabólica e incidência de diabetes após o transplante hepático e fatores associados à sua ocorrência

Abstract

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD), has become the leading cause of chronic liver disease worldwide. Following liver transplantation (LT), patients often gain weight and develop metabolic comorbidities such as obesity, type 2 diabetes mellitus (DM), systemic arterial hypertension and dyslipidemia. The aims of this study were to assess the prevalence of MASLD and incidence of DM after LT, as well as factors associated with its occurrence. Method: A total of 142 patients aged 18 years or older who underwent LT were evaluated. Clinical, anthropometric, and laboratory data were collected. Hepatic ultrasound and elastography using 2D shear-wave technique was performed in all the participants. Results: The median age (IQR) was 60 (47-68) years and 89 (62.7%) were male. The median follow-up time post-LT was 137 (77-205) months. MASLD was identified in 37 (26.1%) participants. The proportion of individuals with central obesity (92% vs. 68%, p=0.006), DM (65% vs 38%, p=0.005), hypertriglyceridemia (51% vs 26%, p=0.008), and metabolic syndrome (69% vs. 41%, p=0.006) was higher in the group with MASLD compared to those without. In multivariate analysis, hypertriglyceridemia (OR = 2.80, 95% CI 1.22-6.43, p= 0.015) and post-LT DM (OR = 2.65, 95%CI 1.15-6.10, p = 0.022) were identified as factors associated with MASLD. Forty-three out 121 individuals (35,5%) developed DM after LT, which was associated with older age (OR = 1.052, 95%CI 1.016-1.090, p = 0.004), longer LT time (OR = 1.008, 95%CI 1.002-1.014, p = 0.009), obesity (OR = 3.480, 95%CI 1.303-9295, p = 0.013), and MASLD (OR = 3.222, 95%CI 1.233-8.419, p = 0.017). The prevalence of advanced hepatic fibrosis (F3 and F4) in patients with MASLD was 8.8%, with no significant difference being observed in relation to patients without MASLD. There was a high prevalence of HAS (54.9%), DM (45.1%), dyslipidemia (60.6%), MS (48.5%) and hypertriglyceridemia (33.3%) after LT. Most patients showed progressive weight gain after LT. The average weight variation was 8.9 ± 11.2 kg, with a prevalence of obesity of 25.4%. Conclusion: The prevalence of MASLD was 26.1% and the incidence of DM after LT was 35.5%. MASLD was associated with DM and hypertriglyceridemia and DM after LT with older age, longer LT time, obesity and MASLD.