Imunossupressão e obesidade no pós-transplante hepático

Abstract

With the current worldwide growth in the number of cases of overweight and obesity, there is a demand for studies to understand the elements involved in the gaining of body weight. It has been demonstrated that obesity is in close association with chronic subclinical inflammation, evidencing the physiological role of the inflammatory response in obesity. In fact, studies have shown that immunosuppressed patients show excessive weight gain, as occurs in liver recipients. Thus, the objective of this study was to investigate whether the compromised inflammatory response of liver recipients affects body weight control. For this, recipients were paired with non-transplanted controls. Both groups were studied for 6 months. During this period, volunteers followed a weight loss dietary planning and were followed to check changes in body weight and composition, dietary adherence and intake, resting energy expenditure, frequency of physical activity, and blood collection. Liver recipients showed lower resting energy expenditure than controls, which may be an important risk factor for excessive weight gain in post-liver transplantation. Transplanted patients also had a similar profile of peripheral blood mononuclear cells when compared to controls, highlighting NK CD8lowCD56 + CD16 + and B lymphocytes, which showed lower and higher frequency, respectively, in the transplant group. In addition, this group had lower serum concentrations of cytokines, such as IFN-, TNF, IL-4, IL-2 and IL-10, and lower inflammatory responsiveness of peripheral blood mononuclear cells under different inflammatory stimuli. After 3 and 6 months of follow up, respectively, the control group lost in average 1.77% and 3.73% of weight, different from the liver transplanted group, which lost only 0.42% and 0.54% of body weight, respectively. In the control group, there was also an improvement in body composition, with decreased fat mass and waist circumference, and lean mass maintenance, which was not observed in the transplanted group. Thus, this work provides evidence that liver recipients are hypometabolic and that inflammation may play an important role in the weight loss process.