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Published on: November 7, 2020
Cardiovascular risk factors in 116 patients 5 years or more after liver transplantation
Consuelo Fernández-Miranda1, Marta Sanz, Angel dela Calle
1Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Ctra. Andalucia km 5.4, 28041 Madrid, Spain. cfmiranda@inicia.es
Insights
Long-term liver transplant recipients show reduced cardiovascular risk factors compared to early post-transplant periods. Their risk factor prevalence mirrors the general Spanish population, suggesting improved management over time.
Area of Science:
- Transplantation Medicine
- Cardiovascular Health
- Immunosuppression Therapy
Background:
- Liver transplantation is a life-saving procedure, but long-term management requires monitoring cardiovascular risk factors (CVRFs).
- Understanding the evolution of CVRFs post-transplantation is crucial for patient outcomes.
Purpose of the Study:
- To assess the prevalence of CVRFs in stable liver transplant patients surviving 5 years or more.
- To compare CVRF prevalence between different immunosuppressive therapies (cyclosporine vs. tacrolimus).
- To compare CVRF prevalence in long-term survivors with the general Spanish population.
Main Methods:
- Cross-sectional study of 116 liver transplant patients with >5 years survival.
- Data collected on smoking, hypertension, obesity, dyslipidemia, diabetes, and hyperhomocysteinemia.
- Comparison of CVRFs based on immunosuppressive agents and with general population data.
Main Results:
- High prevalence of hyperhomocysteinemia (57.8%) and hypertension (49.1%) observed.
- Cyclosporine use associated with higher hypertension, hypercholesterolemia, and hyperhomocysteinemia.
- CVRFs like hypertension and diabetes were lower than at 1 and 3 years post-transplant, likely due to steroid withdrawal.
- No significant difference in CVRF prevalence compared to the general Spanish population.
Conclusions:
- CVRF prevalence in long-term liver transplant survivors is lower than in the early post-transplant period.
- Long-term liver transplant patients' CVRF profile is comparable to the general population.
- Immunosuppressive regimen, particularly cyclosporine, influences specific CVRFs.
Abstract:
We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patients surviving for 5 years or more (median: 102 months). The prevalence of smokers was 29.3%, hypertension 49.1%, obesity 22.4%, hypercholesterolemia 34.5%, hypertriglyceridemia 11.2%, and hyperhomocysteinemia 57.8%. Diabetes was found in 21.5% of the patients, being more frequent in patients with hepatitis-C-virus infection (31.8% vs 15.3%; P=0.03). Patients on cyclosporine therapy had a higher prevalence of hypertension, hypercholesterolemia and hyperhomocysteinemia than those treated with tacrolimus. Multivariate analysis showed only an association between cyclosporine therapy and cholesterol concentrations (odds ratio:1.02; 95% confidence interval (CI): 1.00-1.03; P=0.01). The prevalence of hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia was lower at the time of the study than at 1 and 3 years after transplantation ( P<0.05), probably related to steroid withdrawal. Comparing 87 patients' CVRFs with the general Spanish population, we found that the age-gender standardized prevalence ratio was not different: smoking 1.46 (95% CI: 0.88-1.76), obesity 1.16 (95% CI: 0.60-1.44), hypertension 1.55 (95% CI: 0.98-1.81), and hypercholesterolemia 0.64 (95%CI: 0.35-1.90). We conclude that the prevalence of CVRFs in liver transplant patients after 5 years or more is lower that found in the first years after the transplantation, and no different from that found within the Spanish population.
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