Cardiovascular, metabolic and inflammatory disorders after liver transplantation.

liver transplantation metabolic syndrome cardiovascular risk

drs. E.H. van den Berg
dr. J. Blokzijl

Nature of the research:
The UMCG is one of the three hospitals in the Netherlands that perform liver transplantations. Liver cirrhosis caused by NASH (nonalcoholic steatohepatitis) is projected to become the leading cause of liver transplantation in the future. This project investigates the follow up after liver transplantation concerning steatosis of the liver, metabolic syndrome, cardiovascular problems, diabetes mellitus and an abnormal lipid profile.

Fields of study:

Background / introduction
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are increasingly relevant public health issues, being part of the worldwide epidemics of obesity. NAFLD is currently emerging as the most common cause of chronic liver diseases in the Western world affecting more than one-third of the population in Europe and the US.(1-3) The prevalence of NAFLD in Europe ranges from 20-30% and is increasing over the past years. The spectrum of NAFLD ranges from simple steatosis to NASH and leads to fibrosis, which may progress to cirrhosis and hepatocellular carcinoma (HCC).(4-6) As NAFLD is becoming increasingly common in the developed world, NASH is projected to become the leading cause of liver transplantation.(2)
NAFLD is co morbid with an extended number of the metabolic and inflammatory associated disorders. It coexists frequently with obesity, dyslipidaemia, insulin resistance, metabolic syndrome, type 2 diabetes mellitus and with a positive family history of diabetes.(1,2,4-6) Although most patients with NAFLD are not at risk of dying from liver disease, patients with NASH have a substantial increased risk of early mortality. The top three leading causes of death in patients with NAFLD are cardiovascular disease, cancer and liver disease. In this study we try to identify major determinants of risk management for co morbid disease after transplantation.
Research question / problem definition
Retrospective registration of follow-up data of liver transplant patients. Identification of co morbid, metabolic and inflammatory associated disorders before and after transplantation. Can we predict which people will get metabolic and inflammatory disorders after transplantation, are there any associations?
The student will include data of approximately 120 patients. Subsequently the student will analyze the data and work towards a research article.
1. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology (Baltimore, Md.). 2012. pp. 2005–23.
2. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nature Reviews Gastroenterology and …. 2013.
3. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003 May;98(5):960–7.
4. Wree A, Broderick L, Canbay A, Hoffman HM, Feldstein AE. From NAFLD to NASH to cirrhosis-new insights into disease mechanisms. Nat Rev Gastroenterol Hepatol. 2013 Nov;10(11):627–36.
5. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005 Jul;129(1):113–21.
6. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999 Jun;116(6):1413–9.
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