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

Table 1 Definitions of components of metabolic syndrome

Component	Definition	Criteria (example: ATP III)
Central obesity	Excess fat accumulation around the abdomen	Waist circumference ≥ 102 cm (men), ≥ 88 cm (women)
Hypertriglyceridemia	Elevated triglyceride levels	Triglycerides ≥ 150 mg/dL (1.7 mmol/L)
Low HDL cholesterol	Reduced high-density lipoprotein cholesterol	< 40 mg/dL (men), < 50 mg/dL (women)
Hypertension	Elevated blood pressure	≥ 130/85 mmHg or on antihypertensive treatment
Impaired fasting glucose	Elevated fasting blood glucose indicating insulin resistance or diabetes	Fasting glucose ≥ 100 mg/dL (5.6 mmol/L) or diabetes diagnosis

ATP: Adult treatment panel; HDL: High-density lipoprotein.

Table 2 Management considerations for post-liver transplant metabolic syndrome

Aspect	Management considerations	Notes/challenges
Lifestyle modification	Diet (low saturated fat, sugar), physical activity, weight control	Tailor to immunosuppression side effects
Immunosuppression adjustment	Minimize steroids, consider calcineurin inhibitor-sparing regimens	Balance graft rejection risk vs metabolic risk
Hypertension control	ACE inhibitors or ARBs preferred	Monitor renal function closely
Dyslipidemia treatment	Statins (with liver function monitoring), fibrates if needed	Watch for drug interactions with immunosuppressants
Diabetes management	Lifestyle, oral agents (metformin, SGLT2 inhibitors), insulin if needed	Adjust for renal function and liver metabolism
Regular monitoring	Routine screening for glucose, lipids, blood pressure, and waist circumference	Early detection allows timely intervention
Patient education	Emphasize adherence, lifestyle, and recognition of symptoms	Support via multidisciplinary team
Referral to specialists	Endocrinology, nephrology, nutrition as indicated	Manage complex metabolic and renal issues

ACE: Angiotensin-converting enzyme; SGLT2: Sodium-glucose cotransporter 2.