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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Cardiovascular disease risk in liver transplant recipients transplanted due to chronic viral hepatitis
Paolo Maggi1, Federica Calò1, Vincenzo Messina2
1Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
Insights
Liver transplant recipients for viral hepatitis face high cardiovascular disease risk, often underestimated by standard charts. Early detection of vascular damage is crucial for preventing serious complications.
Area of Science:
- Hepatology
- Cardiology
- Vascular Medicine
Background:
- Cardiovascular disease (CVD) is a significant cause of death post-liver transplant, particularly in those with nonalcoholic steatohepatitis, obesity, and diabetes.
- Limited data exists on CVD in liver transplant recipients with viral hepatitis.
Purpose of the Study:
- To assess cardiovascular risk and subclinical vascular damage in liver transplant recipients with chronic viral hepatitis (HCV, HBV, HDV).
Main Methods:
- Prospective enrollment of 146 adult liver transplant recipients for viral hepatitis.
- Cardiovascular risk estimation using Framingham, ASCVD, and Heart Score risk charts.
- Echocolor-Doppler ultrasound to evaluate carotid artery Intima-Media Thickness (IMT) and detect atherosclerotic plaques.
Main Results:
- A high percentage of patients (83/146) were classified at high cardiovascular risk by Framingham score.
- Carotid ultrasound revealed significant vascular damage: 35.6% had increased IMT and 58.9% had atherosclerotic plaques.
- Only 5.4% of patients showed normal carotid ultrasound findings.
Conclusions:
- Liver transplant recipients for viral hepatitis exhibit substantial subclinical vascular damage, indicating a high CVD risk.
- Traditional cardiovascular risk charts may underestimate the actual vascular risk in this population.
- Raising awareness and early diagnosis of vascular lesions are vital for preventing CVD in liver transplant patients, potentially linked to chronic inflammation.
Background:
Cardiovascular disease (CVD) is a major cause of morbidity and mortality after liver transplantation, mostly in patients transplanted for nonalcoholic steatohepatitis, obesity and diabetes. Few data exist on cardiovascular diseases among patients transplanted for viral hepatitis.
Objective:
Our aim is to clarify the cardiovascular risk and subclinical vascular damage among liver transplant recipients for chronic viral hepatitis (i.e. hepatits C virus, hepatis B virus and hepatitis D virus infection).
Methods:
Adult patients (age ≥ 18 years) with orthotopic liver transplants (OLT) due to viral hepatitis who signed informed consent, and were admitted for a routine follow-up between June 2019 and September 2020 at the Infectious Disease outpatient clinic of the University of Campania Luigi Vanvitelli, Naples, Italy, were prospectively enrolled. An estimation of cardiovascular risk was assessed using three main risk charts, echocolor-Doppler of epiaortic vessels was performed to assess subclinical Intima-Media changes.
Results:
A total of 161 patients were evaluated; of these 15 were excluded because not affected by viral hepatitis. 146 patients were considered. 83 patients (56.8%) were considered at high cardiovascular risk according to Framingham, 54 patients (36.9%) to American Heart Association Arteriosclerotic Cardiovascular Disease (ASCVD) score and 19 (13.0%) to Heart Score. Only 8 patients (5.4%) showed a normal carotid ultrasound, while 52 patients (35.6%) had a carotid artery Intima-Media Thickness (IMT) and 86 (58.9%) an atherosclerotic plaque.
Conclusions:
Liver transplant recipients for virus-related associated liver disease are, in light of the high percentage of carotid lesions, at high risk of CVD. Risk charts compared to subclinical carotid lesions which represent damage already established and a real localization of the disease, seem to underestimate the cardiovascular risk. A chronic inflammatory status, could play a key role. It's important to raise the awareness of cardiovascular risk in liver transplant patients to prevent cardiovascular diseases and improve the timing of early diagnosis of premature vascular lesions.
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