2. Institute for Metabolic Research, Eschersheimer Landstraße 1060322 Frankfurt, Germany.
3. Institute for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
4. Institute for Clinical Research and Development, Parcusstraße 855116 Mainz, Germany.
5. Clinic of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Background: Adiponectin and proinsulin are commonly used biomarkers in patients with metabolic syndrome. In individuals without cirrhosis adiponectin serum levels correlate inversely with insulin resistance and mortality. Proinsulin is a surrogate parameter of β-cell function, its level increases due to β-cell insufficiency while insulin resistance occurs. Metabolic syndrome is often associated with steatohepatitis, and thus liver cirrhosis. An increasing interest in adiponectin and proinsulin as a marker for metabolic syndrome associated morbidity and mortality might be observed in the literature. Still, a diagnostic value of both markers in cirrhotic state is not fully understood.
Methods: Eighteen recipients and donors undergoing living donor liver transplantation were included. Routine parameters, insulin resistance, adiponectin, and proinsulin serum levels were measured at evaluation, 10th, 180th, and 365th postoperative day (POD).
Results: Adiponectin levels before operation were lower in the donor than in the recipient group. Adiponectin levels in donors increased at the 10th and did not change until the 365th POD. In the recipient group levels improved already at 10th and increased slightly till 365th POD. Proinsulin levels in the recipient group were higher before transplantation and improved already at the 10th POD. It decreased continuously till 180th and rose slightly till 365th POD. Proinsulin levels in the donors remained constant regardless of the postoperative acute insulin resistance.
Conclusions: The grade of liver cirrhosis is positively correlated with the adiponectin serum level. In patients with liver cirrhosis, in contrast to liver healthy population, insulin resistance does not cause an adiponectin serum level down regulation. Therefore, the use of adiponectin as a marker of cardiovascular risk associated mortality in patients with cirrhosis is limited. Contrariwise, proinsulin might be used as a marker for hepatic insulin resistance in patients with liver cirrhosis. β-cell insufficiency seems not to play a major role in case of postoperative insulin resistance.
Keywords: Adiponectin, proinsulin, insulin resistance, liver function, liver cirrhosis