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Pro-atherosclerotic markers and cardiovascular risk factors one year after liver transplantation
Mario Reis Alvares-da-Silva1, Claudia Pinto Marques Souza de Oliveira1, José Tadeu Stefano1
1Mario Reis Alvares-da-Silva, Luiz Augusto Carneiro D'Albuquerque, Division of Liver and Gastrointestinal Transplant (LIM-37), Department of Gastroenterology, University of São Paulo School of Medicine, 05508-070 São Paulo, Brazil.
Insights
One year after liver transplantation (LT), patients exhibit pro-atherosclerotic and endothelial dysfunction markers similar to non-alcoholic steatohepatitis (NASH) patients. This suggests a significant atherosclerosis risk in LT recipients, even without obesity.
Area of Science:
- Cardiovascular Medicine
- Transplant Immunology
- Hepatology
Background:
- Liver transplantation (LT) is a life-saving procedure, but recipients face long-term cardiovascular risks.
- Endothelial dysfunction and chronic inflammation are key contributors to atherosclerosis development.
- Assessing pro-atherosclerotic markers post-LT is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate pro-atherosclerotic markers, specifically endothelial dysfunction and inflammation, in liver transplant recipients one year after transplantation.
- To compare these markers between LT patients, non-alcoholic steatohepatitis (NASH) patients, and healthy controls.
- To determine the potential atherosclerosis risk in LT recipients.
Main Methods:
- Forty-four LT outpatients on tacrolimus-based immunosuppression were followed for one year.
- Assessed inflammatory cytokines (TNFα, IFNγ, IL-10), endothelial biomarkers (sVCAM-1, sICAM-1, E-selectin, MMP-9), hs-CRP, and Framingham risk score (FRS).
- Compared LT recipients with 22 NASH patients and 20 healthy controls.
Main Results:
- LT recipients had lower traditional cardiovascular risk factors (e.g., hs-CRP, FRS) than NASH patients.
- However, LT recipients and NASH patients showed similar levels of key inflammatory and endothelial markers compared to controls.
- Specifically, elevated IFNγ, E-selectin, sVCAM-1, and sICAM-1 were observed in both LT and NASH groups.
Conclusions:
- Non-obese liver transplant recipients exhibit pro-atherosclerotic serum profiles comparable to NASH patients one year post-transplant.
- This indicates a heightened risk of atherosclerosis in the LT population, irrespective of traditional risk factors.
- Further research and monitoring are warranted to mitigate cardiovascular complications in LT survivors.
Aim:
To investigate pro-atherosclerotic markers (endothelial dysfunction and inflammation) in patients one year after liver transplantation.
Methods:
Forty-four consecutive liver transplant (LT) outpatients who were admitted between August 2009 and July 2010, were followed-up by for 1 year, exhibited no evidences of infection or rejection, all of them underwent tacrolimus-based immunosuppressive regimens were consecutively enrolled. Inflammatory cytokines (TNFα, IFNγ, IL-8, and IL-10), endothelial biomarkers (sVCAM-1, sICAM-1, MPO, adiponectin, PAI-1, SAP, SAA, E-selectin, and MMP-9), high sensitive C-reactive protein, and Framingham risk score (FRS) were assessed. The anthropometric data, aminotransferases, metabolic syndrome features, glucose and lipid profiles, and insulin resistance data were also collected. The LT recipients were compared to 22 biopsy-proven non-alcoholic steatohepatitis (NASH) patients and 20 healthy controls (non-obese, non-diabetics, and non-dyslipidemic).
Results:
The LT recipients had significantly younger ages and lower body mass indices, aminotransferases, fasting glucose and insulin levels, glucose homeostasis model and metabolic syndrome features than the NASH patients. Classic cardiovascular risk markers, such as Hs-CRP and FRS [2.0 (1.0-8.75)], were lower in the LT patients compared to those observed in the NASH patients (P = 0.009). In contrast, the LT recipients and NASH patients had similar inflammatory and endothelial serum markers compared to the controls (pg/mL): lower IL-10 levels (32.3 and 32.3 vs 62.5, respectively, P = 0.019) and higher IFNγ (626.1 and 411.9 vs 67.9, respectively, P < 0.001), E-selectin (48.5 and 90.03 vs 35.7, respectively, P < 0.001), sVCAM-1 (1820.6 and 1692.4 vs 1167.2, respectively, P < 0.001), and sICAM-1 (230.3 and 259.7 vs 152.9, respectively, P = 0.015) levels.
Conclusion:
Non-obese LT recipients have similar pro-atherosclerotic serum profiles after a short 1-year follow-up period compared to NASH patients, suggesting a high risk of atherosclerosis in this population.
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