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Cardiovascular morbidity and mortality after orthotopic liver transplantation
Simon D Johnston1, Joan K Morris, Rob Cramb
1Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. sdjohnston@utvinternet.com.
Insights
Liver transplant recipients face higher risks of heart disease and death. Hyperlipidemia and hypertension are common, increasing cardiovascular event likelihood post-orthotopic liver transplantation (OLT).
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Liver allograft recipients often experience hyperlipidemia and hypertension, escalating ischemic heart disease (IHD) risk.
- Orthotopic liver transplantation (OLT) necessitates monitoring cardiovascular health due to post-transplant complications.
Purpose of the Study:
- To ascertain the prevalence of IHD risk factors in liver allograft recipients.
- To compare cardiovascular event incidence and mortality in OLT patients against a matched general population.
Main Methods:
- Assessed 110 adult OLT recipients for cardiovascular risk factors including blood pressure, diabetes, smoking, and lipid profiles.
- Collected cardiovascular event and mortality data from a prospective OLT database, comparing it with national registries.
Main Results:
- 44% of patients had raised cholesterol (>5.0 mmol/L) and 63% had systolic hypertension (>140 mmHg).
- Liver allograft recipients showed a 3.07-fold increased risk of ischemic cardiac events and a 2.56-fold increased risk of cardiovascular deaths compared to controls.
Conclusions:
- Liver allograft recipients exhibit significantly higher risks for cardiovascular mortality and ischemic events than the general population.
- The study highlights that moderate hypertension and hyperlipidemia may pose greater risks in OLT patients.
Background:
Hyperlipidemia and hypertension have been reported in liver allograft recipients and contribute to an increased risk of ischemic heart disease (IHD) after orthotopic liver transplantation (OLT). The aims of the study were (1) to determine the prevalence of risk factors for IHD in these patients and (2) to compare the observed incidence of cardiovascular events and related mortality in allograft recipients with a matched population.
Methods:
One hundred ten consecutive adults (50 male) who attended for review after OLT (median follow-up 3.9 years; range 0.1-17.9) were assessed for cardiovascular risk factors using current blood pressure, diabetic status, and smoking history and measurements of total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. Cardiovascular events and cardiovascular mortality data were collected from the prospective database of all adult liver allograft recipients and compared to matched data from myocardial infarction registries and Office for National Statistics data, respectively.
Results:
Raised serum cholesterol (>5.0 mmol/L) was found in 48 (44%) patients (18 male), and systolic hypertension (>140 mmHg) was found in 69 (63%) patients (27 male). The relative risk of ischemic cardiac events was 3.07 (95% [confidence interval] CI, 1.98-4.53) and the relative risk for cardiovascular deaths was 2.56 (95% CI, 1.52-4.05) in allograft recipients compared to an age-matched population without transplants.
Conclusions:
Liver allograft recipients have a greater risk of cardiovascular deaths and ischemic events than an age- and sex-matched population. The prevalence of raised cholesterol concentrations in patients after OLT is similar to those in previous reports. Moderate hypertension and hyperlipidemia may be more detrimental in patients after OLT compared to non-transplant patients without these risk factors.