ABSTRACT Objective Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. Subjects and methods Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. Results A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. Conclusion Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. Arch Endocrinol Metab. 2020;64(3):235-42

RESUMO OBJETIVO: Investigar fatores de risco para o desenvolvimento de doença renal crônica e óbito dois anos após transplante hepático. MÉTODO: Associações entre parâmetros clínicos e laboratoriais e o desenvolvimiento de doença renal crônica e sobrevida dois anos pós-transplante hepático foram analisados em uma coorte de 148 pacientes adultos, com cirrose hepática, submetidos consecutivamente a transplante de fígado em centro de referência no Brasil. RESULTADOS: A idade mediana ao transplante hepático foi 56 (limites, 20-73) anos, e 105 (70,9%) pacientes eram do gênero masculino. A prevalência de doença renal crônica dois anos pós-transplante hepático foi: estádio 1 ou ausência de doença renal, 27,5%; estádio 2, 33,8%; estádio 3, 34,6%; estádios 4-5, 4,7%. Quatro variáveis apresentaram associação independents com o estádio de doença renal crônica, dois anos pos-transplante hepático: (i) idade ao transplante hepático, (ii) gênero masculino, (iii) mediana dos níveis de tacrolimus nos primeiros três meses pós-transplante hepático e (iv) mediana das concentrações séricas de creatinina nos primeiros seis meses pós-transplante hepático. Duas variáveis apresentaram associação independents com óbito dois anos pós-transplante hepático: permanência em Unidade de Terapia Intensiva por três ou mais dias após a cirurgia de transplante, e mediana das concentrações séricas de creatinina nos primeiros seis e três meses após o transplante hepático igual ou superior a 1,3 mg/dL. CONCLUSÕES: Administração da menor dose eficaz de tacrolimus e adoção de medidas para preservar a função renal são medidas importantes para se reduzir o risco de desenvolvimento de doença renal crônica, tardiamente, após o transplante de fígado, especialmente nos pacientes que apresentam fatores de risco.

OBJECTIVE: To investigate risk factors for the development of chronic kidney disease and death two years postliver transplantation. METHOD: Associations between clinical and laboratory parameters and the development of chronic kidney disease and survival two years post-liver transplant were analyzed in a cohort of 148 adult patients with hepatic cirrhosis consecutively submitted to liver transplantation in a referral Brazilian center. RESULTS: Median age at liver transplantation was 56 (range, 20-73) years, and 105 (70.9%) patients were males. The prevalence of chronic kidney disease at two years post-liver transplantation was: stage 1 or no chronic kidney disease, 27.5%; stage 2, 33.8%; stage 3, 34.6%; stages 4-5, 4.7%. Four variables were independently associated with the stage of chronic kidney disease two years after liver transplantation: (i) age (at liver transplantation), (ii) male gender, (iii) median tacrolimus levels in the first three months post-liver transplantation, and (iv) median of serum creatinine in the first six months post-liver transplantation. Two variables showed independent association with death in two years post-liver transplantation: (i) stay in Intensive Care Unit for three or more days after the liver transplantation surgery and (ii) median of serum creatinine levels in the first six months post-liver transplantation equal or higher than 1.3 mg/dL. CONCLUSIONS: Administration of the lowest effective dose of tacrolimus and adoption of strategies to spare renal function are important measures to reduce the risk of late chronic kidney disease and death post-liver transplantation especially in high risk patients.