Metabolic syndrome after liver transplantation: A silent threat to long-term success

Abstract

Liver transplantation (LT) has significantly improved survival for patients with end-stage liver disease, but post-transplant metabolic syndrome (MetS) has emerged as a major challenge, affecting graft function and long-term outcomes. Characterized by obesity, dyslipidemia, hypertension, and insulin resistance, MetS increases the risk of cardiovascular disease, recurrent liver disease, and reduced graft survival. We systematically examine current literature on the diagnosis, risk stratification, and management of MetS in LT recipients, with a focus on lifestyle interventions, pharmacologic strategies, and potential modifications in immunosuppressive regimens. Additionally, we discuss the role of emerging therapies, including GLP-1 receptor agonists, PCSK-9 inhibitors, and bariatric interventions, in mitigating metabolic risk in this population. With cardiovascular complications being the leading cause of post-LT mortality, proactive management of MetS is crucial. A multidisciplinary approach integrating hepatology, endocrinology, and cardiology is essential to optimize patient outcomes. Future research should focus on personalized metabolic interventions and long-term strategies to enhance post-transplant survival and quality of life.

Keywords: Liver transplantation; Metabolic syndrome; Post-transplant diabetes mellitus; Immunosuppression; Cardiovascular disease; Metabolic dysfunction associated steatohepatitis

Core Tip: Metabolic syndrome (MetS) is increasingly recognized as a major contributor to morbidity and mortality after liver transplantation. This review highlights the pathophysiology, epidemiology, and clinical impact of post-transplant MetS. We also outline current strategies for screening, prevention, pharmacological treatment and surgical management.