Backround

Metabolic syndrome (MS) is seen in a high rate of heart transplant patients. In recent studies MS has been associated with long-term complications. The aim of this analysis was to evaluate the impact of MS on long-term outcome after heart transplantation.

Patients and methods

307 adult one-year survivors after heart transplantation were analysed between 1997-2009. All had a BMI <30 at time of transplant. Metabolic syndrome was defined using the NCEP- ATP III criterias and the modification from the AHA 2005. Patients were divided in two groups (I: development of MS within 12 mnoths post transplantation, II: no MS within 12 months post transplantation). Long-term outcome (survival, severe graftvascuopathy (CAV ≥ 50% stenosis in any coronary vessel)) were compared between groups by Kaplan- Meier- analysis and Cox regression. Pre-TX factors were analyzed on their impact to develop MS post transplantation.

Results

121 (39.4%) patients developed MS during the first 12 months after transplantation. 5- and 10-year survival was significantly lower in Group I (5 years: 85.1% vs. 95.1%; p=0.002; 10 years: 70% vs. 81.1%; p= 0.006) Patients in group I had a higher rate of death from of cancer (7% vs. 1.6%; p=0.032) and CAV (8.3% vs 2.7%; p=0.014) Group 1 had a significantly higher rate of severe CAV (45% vs. 20% ;p= 0,008) A Body mass index ≥ 25 before HTX (30% vs. 51%; p<0,001) as well as age >35a (20% vs. 41.5% p=0.022) were associated with a higher risk to develop MS Syndrome during the first year after HTX.

Conclusion

Development of MS during the first year after transplantation is a significant risk factor for Long-term survival and CAV development. Higher age and BMI at the time of transplant are associated with a higher risk to develop MS. Mechanisms of intervention a strongly needed to counteract.

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