Abstract
Liver transplanted patients are at high risk of metabolic syndrome and its complications.
We aimed to prospectively evaluate the early onset of cardiovascular alterations in
patients submitted to the transplant waiting list. From January 2014 to January 2016,
54 out of 79 patients on the waiting list with decompensated cirrhosis or hepatocellular-carcinoma
received the transplant, 50 were followed for 24 months, 2 died post-surgery and 2
were lost to follow-up. A significantly increased prevalence of visceral adiposity
(epicardial adipose tissue thickness (p = 0.001) and worsening of carotid damage (p = 0.003) and diastolic dysfunction (E/A p = 0.001) was observed at 6 months after transplant and remained stable at 24 months,
corresponding to an increased prevalence of diabetes, metabolic syndrome, hypertension
and dyslipidemia. The duration of steroid therapy, withdrawn in the majority of patients
at 3 months, did not influence cardiovascular damage. No significant difference in
early progression of cardiovascular damage was observed between patients who did or
did not receive a graft with steatosis.
Conclusion
The occurrence of early cardiovascular alterations in the first 6 months after OLT
accounts for the reported cardiovascular events in the first years after transplant.
In light of these results, new strategies aimed at preventing or delaying cardiovascular
alterations should be provided, starting from the first weeks after transplant.
Keywords
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References
- 2018 annual report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation.Transpl Int. 2018; 31: 1293-1317
- Metabolic complications after liver transplantation. Diabetes, hypercholesterolemia, hypertension, and obesity.Transplantation. 1995; 60: 1057-1060
- Cumulative risk of cardiovascular events after orthotopic liver transplantation.Liver Transpl. 2012; 18: 370-375
- Time-varying impact of comorbidities on mortality after liver transplantation: a national cohort study using linked clinical and administrative data.BMJ Open. 2015; e006971
- Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study.Am J Transplant. 2010; 10: 1420-1427
- Hypertension and renal dysfunction in long-term liver transplant recipients.Liver Transpl. 2001; 7: S22-S26
- Diabetes mellitus, and not obesity, is associated with lower survival following liver transplantation.Dig Dis Sci. 2015; 60: 1036-1044
- Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States.Gastroenterology. 2015; 148: 547-555
- Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events.Hepatology. 2012; 56: 1741-1750
- Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events.Liver Transpl. 2011; 17: 15-22
- Subclinical cardiovascular changes in pediatric solid organ transplant recipients: a systematic review and meta-analysis.Pediatr Transplant. 2016; 20: 530-539
- Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors.Eur Heart J. 2013; 34: 2368-2380
- Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.Circulation. 2007; 115: 459-467
- Subclinical atherosclerosis is associated with Epicardial Fat Thickness and hepatic steatosis in the general population.Nutr Metab Cardiovasc Dis. 2016; 26: 141-153
- Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects.J Am Coll Cardiol. 2014; 63: 636-646
- Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.J Am Coll Cardiol. 2010; 55: 1318-1327
- Epicardial adipose tissue (EAT) thickness is associated with cardiovascular and liver damage in nonalcoholic fatty liver disease.PLoS One. 2016; 11e0162473
- Epicardial adipose tissue as new cardio-metabolic risk marker and potential therapeutic target in the metabolic syndrome.Curr Pharm Des. 2007; 13: 2180-2184
- Epicardial fat: a new cardiovascular therapeutic target.Curr Opin Pharmacol. 2016; 27: 13-18
- Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis.Atherosclerosis. 2012; 221: 496-502
- Hepatitis C virus infection increases the risk of developing peripheral arterial disease: a 9-year population-based cohort study.J Hepatol. 2015; 62: 519-525
- Cardiovascular disease in cirrhosis—a point-prevalence study in relation to glucose tolerance.Am J Gastroenterol. 1999; 94: 655-662
- Reduced prevalence of ischemic events and abnormal supraortic flow patterns in patients with liver cirrhosis.Liver Int. 2005; 25: 331-336
- Microsteatosis may not interact with macrosteatosis in living donor liver transplantation.J Hepatol. 2015; 62: 556-562
- Excellent outcomes of liver transplantation using severely steatotic grafts from brain-dead donors.Liver Transpl. 2016; 22: 226-236
- De novo hepatic steatosis drives atherogenic risk in liver transplantation recipients.Liver Transpl. 2015; 21: 1395-1402
- Review on immunosuppression in liver transplantation.World J Hepatol. 2015; 7: 1355-1368
- European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).Eur Heart J. 2012; 33: 1635-1701
- Echocardiographic imaging in clinical trials: American Society of Echocardiography Standards for echocardiography core laboratories: endorsed by the American College of Cardiology Foundation.J Am Soc Echocardiogr. 2009; 22: 755-765
- Carotid artery intima-media thickness in nonalcoholic fatty liver disease.Am J Med. 2008; 121: 72-78
- Reference values for local arterial stiffness. Part A: carotid artery.J Hypertens. 2015; 33: 1981-1996
- Beta stiffness – setting age standards.Acta Clin Croat. 2009; 48: 253-258
- Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies.Liver Transpl. 2012; 18: 1140-1146
- Metabolic syndrome after liver transplantation: short-term prevalence and pre- and post-operative risk factors.Dig Liver Dis. 2013; 45: 833-839
- Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: a population-based study.Hepatology. 2015; 62: 773-783
- Epicardial fat in patients with non-alcoholic fatty liver disease.J Hepatol. 2015; 62: 1215
- Cardiovascular risk factors in 116 patients 5 years or more after liver transplantation.Transpl Int. 2002; 15: 556-562
- Prevalence and distribution of sub-clinical atherosclerosis by screening vascular ultrasound in low and intermediate risk adults: the New York physicians study.J Am Soc Echocardiogr. 2009; 22: 1145-1151
- Carotid atherosclerosis and chronic hepatitis C: a prospective study of risk associations.Hepatology. 2012; 55: 1317-1323
- Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study.World J Gastroenterol. 2016; 22: 8869-8882
- A comparison of tacrolimus and cyclosporine in liver transplantation: effects on renal function and cardiovascular risk status.Am J Transplant. 2005; 5: 1111-1119
- Impact of tacrolimus and mycophenolate mofetil regimen vs. a conventional therapy with steroids on cardiovascular risk in liver transplant patients.Clin Transplant. 2015; 29: 667-677
- Impact of the cardiovascular system-associated adipose tissue on atherosclerotic pathology.Atherosclerosis. 2017;
- Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease, and association with visceral obesity.Clin Gastroenterol Hepatol. 2017;
- Non-alcoholic fatty liver disease and liver transplantation.Metabolism. 2016; 65: 1208-1223
- Excellent outcomes of liver transplantation using severely steatotic grafts from brain-dead donors.Liver Transpl. 2016; 22: 377-378
- NAFLD and liver transplantation: current burden and expected challenges.J Hepatol. 2016; 65: 1245-1257
- Nonalcoholic fatty liver disease after liver transplantation for cryptogenic cirrhosis or nonalcoholic fatty liver disease.Liver Transpl. 2010; 16: 431-439
- Long term outcomes in patients undergoing liver transplantation for nonalcoholic steatohepatitis related cirrhosis.Transplantation. 2017;
Article info
Publication history
Published online: September 11, 2019
Accepted:
July 15,
2019
Received:
January 6,
2019
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Reply to Comment: Is there any place for SGLT2-inhibitors in post-liver transplantation patients?Digestive and Liver DiseaseVol. 52Issue 4
- PreviewWe were pleased to read the letter by Dr Patoulias, “Is there any place for sodium-glucose co-transporter 2 inhibitors in post-liver transplantation patients?”, commenting our study. We agree with the Authors on the possible beneficial effect of SGLT2-inhibitors use for patients who underwent orthotropic liver transplantation (OLT), given the absolute need for new therapeutic strategies able to prevent cardiac and atherosclerotic damage.
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