Metabolic Syndrome After Kidney Transplantation A. Faenza, G. Fuga, B. Nardo, G. Donati, G. Cianciolo, M.P. Scolari, and S. Stefoni ABSTRACT Background. Metabolic syndrome (MS) includes some risk factors for development of diabetes and cardiovascular disease, obesity (BMI  30), high triglycerides, low HDL cholesterol, hypertension and impaired glucose tolerance. Following the definition of the Adult Treatment Panel III criteria, a diagnosis of MS was established when 3 or more factors were present. In renal transplan patients MS has been reported to negatively influence both patient and graft survivals. The present study sought to verify the effect of MS among our cases. Methods. 298 cadaveric renal transplant recipients operated between January 1, 1996 and December 31, 2001 with absence of diabetes before transplantation, stable renal function 1 year posttransplantation and at least 4 years follow up were retrospectively evaluated from the end of the first post-operative year. Results. 50 patients out of 298 (16,7%) had MS at the beginning of the study, including 37 of them with 3 and 13 with 4 risk factors. Only one patient with MS died of cardiovascular disease. Graft failure was observed in 23.5% MS patients versus 9,7% patients without the Syndrome (p:n.s.) Only Creatinine and the incidence of Cardiovas- cular Diseases at 4 years were statistically higher in MS patients (P  .001). Conclusions. These results suggested that MS is a risk factor for increasing CVD morbidity and decreased graft function, but early treatment of risk factors as soon as they become apparent can limit the adverse effects on patient and graft survival. O NE-YEAR cadaver kidney graft survival has continu- ously improved during the last 10 to 15 years. The late results have not followed the same tendency and are quite stable. 1 The leading causes of graft loss in the renal transplant population are death with functioning graft and chronic allograft nephropathy. 1,2 The main causes of death in more than 30% of renal transplant recipients, both in the 2004 USRDS report and in our caseload statistics from 1967, was of cardiovascular origin. 1,2 Many risk factors for cardiovascular diseases have been identified in the general population and in dialysis patients: dislipidemia, hyperten- sion, impaired glucose tolerance, obesity, physical inactivity, high homocysteine and prothombotic factors. 3,4 After kid- ney transplantatation the cardiovascular morbidity and mor- tality generally decrease in comparison with waiting list pa- tients although some risk factors improved and others worsened or appeared de novo. 5 De novo Diabetes, for instance, negatively influences both patient and graft survival. The metabolic syndrome (MS), which was first described in 1989, gathers some of the risk factors: as an useful tool to forecast and prevent postoperative diabetes and CVD. 6 Obesity, with central obesity as waist circumference or as BMI in different definitions of MS, high triglycerides, low HDL cholesterol, hypertension and impaired glucose toler- ance. In 10 years more than 1000 papers have appeared on MS in Med Line, despite a joint provocative discussion paper of The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) a suggesting that MS has been largely driven by the industry to create new markets. 7 In contrast, the Interna- tional Diabetes Federation (IDF) states that the MS serves a useful purpose to focus on people, in both community and clinical settings, who are at high risk for developing CDV or From the Departments of Kidney Transplant Surgery (A.F., G.F., B.N.), and Nephrology, Dialysis and Transplantation (G.D., G.C., M.P.S., S.S.), University of Bologna, Italy. Address reprint requests to Prof. Alessandro Faenza, Chiru- rgia Trapianti di Rene, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy. E-mail: alessandro.faenza@unibo.it © 2007 by Elsevier Inc. All rights reserved. 0041-1345/07/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.07.019 Transplantation Proceedings, 39, 1843–1846 (2007) 1843