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Does Atherosclerosis Progress Faster After Liver Transplant? A Comparative Study and Analysis of Progression Risk
Giulia Pagano1,2,3, Judit Mestres-Martí4, Cautar El Maimouni1,2
1Liver Transplant Unit, Hospital Clínic, Barcelona, Spain, hospitalclinic.org.
Insights
Cardiovascular disease progression after liver transplantation (LT) was similar to patients awaiting LT. Optimized cardiovascular risk factor control and minimized immunosuppression did not accelerate coronary artery calcium score (CACS) progression post-LT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) may progress faster post-liver transplantation (LT) due to risk factors and immunosuppression.
- Coronary artery calcium score (CACS) progression is a CVD prognostic biomarker, with limited data post-LT or in cirrhosis.
Purpose of the Study:
- To compare 5-year CACS progression in LT recipients versus non-LT patients with cirrhosis.
- To identify predictors of CACS progression after LT, including cardiovascular risk factors and immunosuppression.
Main Methods:
- Compared 5-year CACS progression in 75 LT recipients and 20 non-LT patients.
- Measured CACS at LT evaluation and 5 years post-LT.
- Assessed 1-year post-LT cardiovascular risk factors and tacrolimus exposure.
Main Results:
- CACS increased in both groups (LT: 23 AU/year, non-LT: 30 AU/year; p=0.833).
- Higher pre-LT CACS and worse post-LT renal function predicted CACS progression.
- No immunosuppression variables correlated with CACS progression.
Conclusions:
- LT recipients with controlled risk factors and standard/minimized immunosuppression showed similar CACS progression to non-LT patients.
- Post-transplant renal function warrants further investigation regarding its association with CACS progression.
Background:
Cardiovascular disease (CVD) is thought to evolve faster after liver transplantation (LT) due to an increased prevalence of cardiovascular risk (CVR) factors and the use of immunosuppression. The progression of coronary artery calcium score (CACS) in computed tomography is a prognostic biomarker of CVD. There is scarce information about CACS changes after LT or in patients with cirrhosis.
Methods:
We compared the 5-year progression of CACS in two populations: 75 LT recipients and 20 patients with cirrhosis assessed for LT but who eventually did not undergo LT (non-LT). In both populations, CACS was measured at LT evaluation and 5 years thereafter. Additionally, we studied 1-year post-LT CVR factors and immunosuppression parameters, including cumulative exposure to tacrolimus (CET) as potential predictors of 5-year CACS progression after LT.
Results:
Both groups were comparable regarding CVR factors, time between CACS, or baseline CACS. CACS increased in both groups, with an annualized progression of 23 Agatston units (AU)/year in LT and 30 AU/year in non-LT (p = 0.833). CVR factors control after LT was optimal, and 80% received standard/minimized CET. Higher pre-LT CACS (p < 0.001) and worse kidney function 12 months after transplantation (p = 0.003) independently predicted progression after LT. No immunosuppression-related variables were associated with CACS progression.
Conclusion:
In LT recipients with optimized control of CVR factors and standard/minimized CET, CACS progression was not faster than in patients with cirrhosis. The association between posttransplant renal function and CACS progression warrants further investigation.
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