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Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation
O Guckelberger1, W O Bechstein, R Neuhaus
1Department of Surgery, Virchow Clinic, Humboldt University, Berlin, Germany.
Insights
Orthotopic liver transplantation (OLT) significantly increases cardiovascular risk factors like hypertension and hypercholesterolemia. Tacrolimus-based immunosuppression may offer a better cardiovascular profile post-OLT compared to Cyclosporin A.
Area of Science:
- Cardiovascular Medicine
- Transplantation Surgery
- Clinical Pharmacology
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for end-stage liver disease.
- Cardiovascular risk factors are a significant concern in post-transplant patients.
- The impact of immunosuppressive regimens on cardiovascular health after OLT requires further investigation.
Purpose of the Study:
- To evaluate the incidence and trends of cardiovascular risk factors following OLT.
- To compare the prevalence of cardiovascular risk factors between different immunosuppressive agents.
Main Methods:
- Retrospective review of 302 adult patients undergoing OLT.
- Analysis of cardiovascular risk factors including arterial hypertension, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, and obesity.
- Comparison of risk factor prevalence based on immunosuppressive agents (cyclosporin A vs. tacrolimus) and follow-up duration.
Main Results:
- A significant increase in cardiovascular risk factors was observed post-OLT.
- Hypercholesterolemia (66.2%), hypertriglyceridemia (49.7% in males), arterial hypertension (45%), and hyperglycemia (higher in males) were prevalent.
- Tacrolimus use was associated with a lower prevalence of hypercholesterolemia and a trend towards lower rates of other cardiovascular risk factors compared to cyclosporin A.
Conclusions:
- OLT is associated with a substantial burden of cardiovascular risk factors.
- Tacrolimus-based immunosuppression may be associated with a more favorable cardiovascular risk profile post-OLT.
- Long-term monitoring and management of cardiovascular health are crucial for OLT recipients.
Abstract:
In a retrospective study the records of 302 adult patients (167 male, 135 female) after orthotopic liver transplantation (OLT) with a minimum follow-up of 6 months (median follow-up 18 months, maximum 5 yr) were reviewed with regard to cardiovascular risk factors. In 197 patients data concerning the occurrence of arterial hypertension, hyperglycemia, or hypercholesterolemia prior to OLT were available. We found a highly significant increase of cardiovascular risk factors following OLT. Obesity was found in 17.4% of male and 22.2% of female recipients after OLT. Hypercholesterolemia was evident in 66.2% of liver graft recipients. Hypertriglyceridemia occurred in 49.7% of all male patients. In females there was a significantly different prevalence of hypertriglyceridemia comparing patients with a follow-up period up to 2 yr and more than 2 yr (50% vs. 24.6%, p = 0.018). Nearly 45% of all patients met the criteria for arterial hypertension, with a slight increase in male patients beyond the second year of survival (p = 0.094). Hyperglycemia had a significantly higher frequency in male than in female patients (30.5% vs. 10.4%, p < 0.005). Furthermore we observed a clear trend towards reduction of occurrence of hyperglycemia more than 24 months after OLT, but not reaching statistical significance. No correlation was detected when serum levels of triglycerides, and cholesterol, body-mass-index, and arterial blood pressure were compared with applied dosages of immunosuppressive agents [cyclosporin A (CyA), tacrolimus, and prednisolone]. Only decreasing tacrolimus application was significantly correlated with decreasing glucosemia (p = 0.041). Patients receiving tacrolimus instead of CyA as primary immunosuppressant showed a significantly lower prevalence of hypercholesterolemia. Even hypertension, hyperglycemia, hypertriglyceridemia, and obesity had a lower occurrence in patients treated with tacrolimus although not reaching statistical significance.