Markers of the Hepatic Component of the Metabolic Syndrome as Predictors of Mortality in Renal Transplant Recipients

D. M. Zelle, E. Corpeleijn, R. M. van Ree, R. P. Stolk, E. van der Veer, R. O. B. Gans, J. J. Homan van der Heide, G. Navis, S. J. L. Bakker*, der van, [No Value] Homan van der Heide JJ

*Corresponding author for this work

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Abstract

Cardiovascular disease (CVD) is a leading cause of mortality in renal transplant recipients (RTRs). Metabolic syndrome (MS) is highly prevalent in RTRs. Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic component of MS. We investigated associations of NAFLD markers with MS and mortality. RTRs were investigated between 2001 and 2003. NAFLD markers, alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (AP) were measured. Bone and nonbone fractions of AP were also determined. Death was recorded until August 2007. Six hundred and two RTRs were studied (age 52 +/- 12 years, 55% men). At baseline 388 RTRs had MS. Prevalence of MS was positively associated with liver enzymes. During follow-up for 5.3[4.5-5.7] years, 95 recipients died (49 cardiovascular). In univariate Cox regression analyses, GGT (HR = 1.43[1.21-1.69], p <0.001) and AP (HR = 1.34[1.11-1.63], p = 0.003) were associated with mortality, whereas ALT was not. Similar associations were found for cardiovascular mortality. Adjustment for potential confounders, including MS, diabetes and traditional risk factors did not materially change these associations. Results for nonbone AP mirrored that for total AP. ALT, GGT and AP are associated with MS. Of these three enzymes, GGT and AP are associated with mortality, independent of MS. These findings suggest that GGT and AP are independently related to mortality in RTRs.

Original languageEnglish
Pages (from-to)106-114
Number of pages9
JournalAmerican Journal of Transplantation
Volume10
Issue number1
DOIs
Publication statusPublished - Jan-2010

Keywords

  • Cardiovascular risk factors
  • fatty liver disease
  • mortality
  • renal transplant patients
  • GAMMA-GLUTAMYL-TRANSFERASE
  • FATTY LIVER-DISEASE
  • TYPE-2 DIABETES-MELLITUS
  • CARDIOVASCULAR-DISEASE
  • INSULIN-RESISTANCE
  • OXIDATIVE STRESS
  • ALANINE AMINOTRANSFERASE
  • RISK
  • ATHEROSCLEROSIS
  • TRANSPEPTIDASE

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