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Hyperhomocysteinemia in liver transplant recipients: prevalence and multivariate analysis of predisposing factors
J I Herrero1, J Quiroga, B Sangro
1Liver Unit, Clínica Universitaria, University of Navarra, Pamplona, Spain. iherrero@unav.es
Insights
Hyperhomocysteinemia, high homocysteine levels, is common in liver transplant recipients and linked to kidney problems. Folic acid treatment effectively lowered homocysteine levels in most patients studied.
Area of Science:
- Nephrology
- Cardiology
- Hepatology
Background:
- Liver transplant recipients face increased cardiovascular disease risk due to obesity, hypertension, diabetes, and hyperlipidemia.
- Hyperhomocysteinemia is a recognized risk factor for cardiovascular disease.
- Elevated homocysteine levels are prevalent in liver transplant populations.
Purpose of the Study:
- To determine the prevalence of hyperhomocysteinemia in liver transplant recipients.
- To investigate associations between hyperhomocysteinemia and clinical factors, including renal function.
- To evaluate the efficacy of folic acid treatment in reducing homocysteine levels.
Main Methods:
- Fasting serum homocysteine levels were measured in 105 liver transplant recipients.
- Hyperhomocysteinemia was defined as homocysteine > 13 micromol/L.
- Associations were analyzed using univariate and multivariate methods; 10 patients received folic acid treatment.
Main Results:
- Hyperhomocysteinemia was detected in 27% of patients.
- It was associated with hepatitis C virus, mycophenolate mofetil use, and elevated alkaline phosphatase, gamma-glutamyl transpeptidase, urea, and creatinine.
- Multivariate analysis linked hyperhomocysteinemia significantly to higher creatinine levels (P=.006).
Conclusions:
- Hyperhomocysteinemia is frequent in liver transplant recipients and associated with renal dysfunction.
- Folic acid treatment significantly reduced homocysteine levels in most patients.
- This suggests a potential therapeutic role for folic acid in managing cardiovascular risk in this population.
Abstract:
Liver transplant recipients have an increased risk for cardiovascular disease because of a high incidence of obesity, arterial hypertension, diabetes mellitus, and hyperlipidemia. Hyperhomocysteinemia has been found to be an important risk factor for cardiovascular disease in large studies. Fasting serum levels of homocysteine were measured in 105 liver transplant recipients, and hyperhomocysteinemia was defined as a fasting serum homocysteine level greater than 13 micromol/L. Patients with versus without hyperhomocysteinemia were compared. The possible association of hyperhomocysteinemia with age, sex, cause of liver disease, time elapsed since liver transplantation, immunosuppressive therapy, folic acid level, liver function test results, renal function, and other cardiovascular risk factors was investigated. Patients with serum homocysteine levels greater than 15 micromol/L were treated with folic acid, 10 mg/d, and serum homocysteine levels were measured again 1 to 3 months later in 10 patients. Hyperhomocysteinemia was detected in 28 patients (27%). In univariate analysis, it was associated with hepatitis C virus infection, treatment with mycophenolate mofetil, and greater serum levels of alkaline phosphatase, gamma-glutamyl transpeptidase, urea, and creatinine. In multivariate analysis, only greater serum levels of creatinine (P =.006) were associated with hyperhomocysteinemia. Treatment with folic acid resulted in a decrease in fasting serum homocysteine levels in 9 of the 10 patients tested (P =.01). Hyperhomocystinemia, associated with renal dysfunction, is a frequent finding in liver transplant recipients. Treatment with folic acid may reduce fasting homocysteine levels.