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Cardiovascular morbidity and mortality is increased post-liver transplantation even in recipients with no pre-existing risk factors

De Luca, L; Kalafateli, M; Bianchi, S; Alasaker, N; Buzzetti, E; Rodríguez-Perálvarez, M; Thorburn, D; ... Tsochatzis, EA; + view all (2019) Cardiovascular morbidity and mortality is increased post-liver transplantation even in recipients with no pre-existing risk factors. Liver International , 39 (8) pp. 1557-1565. 10.1111/liv.14185. Green open access

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Abstract

BACKGROUND/AIMS: Post-liver transplant (LT) metabolic syndrome (PTMS) and cardiovascular (CVS) mortality are becoming increasingly prevalent following sustained improvements in post-LT survival. We investigated the prevalence and predictors of PTMS and CVS complications in a cohort of consecutive LT recipients. METHODS: We reviewed prospectively collected data of patients (n=928) who underwent LT (1995-2013) and survived at least 1-year post-LT or died before that due to a major CVS complication. RESULTS: Median follow-up was 85 months (IQR=106). The prevalence of PTMS was 22.4% and it developed de novo in 183 recipients (19.7%). A total of 187 (20.2%) patients developed at least one CVS event post-LT within a median of 49 months (IQR=85). Overall mortality rate was 22.6% (n=210). Causes of death were CVS events (n=45, 21.4%), malignancies (21%), liver related deaths (20%) and infections (6.7%). Independent predictors of major CVS events were: documented CVS disease pre-LT (Hazard Ratio (HR)=3.330; 95%CI=1.620-6.840), DM (HR=1.120; 95%CI 1.030-1.220), hypertension (HR=1.140; 95%CI 1.030-1.270), dyslipidaemia (HR=1.140; 95%CI 1.050-1.240) and creatinine levels at 1 year (HR=1.010; 95%CI=1.005-1.013). Among LT recipients without pre-LT CVS disease or MS components (n=432), 85 recipients developed ≥1 CVS events (19.7%) with independent predictors being DM (HR=1.150; 95%CI=1.010-1.320), creatinine levels at 1 year (HR=1.020; 95%CI=1.010-1.030), and hypertension (HR=1.190; 95%CI=1.040-1.360). CONCLUSIONS: Post-LT patients are at increased risk of CVS morbidity even in the absence of pre-existing metabolic risk factors. Renal sparing immunosuppressive protocols might reduce CVS events post-LT. This article is protected by copyright. All rights reserved.

Type: Article
Title: Cardiovascular morbidity and mortality is increased post-liver transplantation even in recipients with no pre-existing risk factors
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/liv.14185
Publisher version: https://doi.org/10.1111/liv.14185
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Diabetes, immunosuppression, metabolic syndrome, renal function, statins
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10077036
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