Cardiovascular morbidity and mortality after liver transplantation: The protective role of Mycophenolate Mofetil
D'Avola D (1), Cuervas-Mons V (2), Martí J (3), Ortiz de Urbina J (4), Lladó L (5), Jimenez C (6), Otero E (7), Suarez F (8), Rodrigo JM (9), Gómez MA (10), Fraga E (11), Lopez P (12), Serrano T (13), Rios A (14), Fábrega E (15), Herrero JI (1).
(1) Liver Unit, Clinica Universidad de Navarra, CIBERehd and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona.
(2) Internal Medicine, Liver transplantation, Hospital Clínica Puerta de Hierro Madrid.
(3) Institut de Malaties Digestives i Metabòliques, Hospital Clinic de Barcelona, CIBERehd, IDIBAPS.
(4) Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario de Cruces, Bilbao.
(5) Liver Surgery and Transplant Unit, Hospital Universitari de Bellvitge IDIBELL.
(6) Department of Surgery, Hospital 12 de Octubre, Madrid.
(7) Department of Internal Medicine, Abdominal Transplant Unit, Hospital Clínico Universitario de Santiago de Compostela.
(8) LiverTransplant Unit, Hospital Universitario de A Coruña, La Coruña.
(9) Gastroenterology Department, Hospital Regional Universitario de Málaga, Malaga.
(10) Liver Transplant Unit, Hospital Virgen del Rocío, Sevilla.
(11) Department of Hepatology, Hospital Universitario Reina Sofía, Córdoba.
(12) Department of Surgery, Hospital Ramón y Cajal, Madrid.
(13) Department of Gastroenterology, Liver Unit, Hospital Universitario Lozano Blesa, Zaragoza.
(14) Transplant Unit, Surgery Service, Hospital Universitario Virgen de la Arrixaca.
(15) Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla.
Cardiovascular (CV) diseases are recognized long-term causes of death after liver transplantation (LT).
The objective of this multicenter study was to analyse the prevalence and the evolution of CV risk factors and CV morbidity and mortality in 1819 liver transplant recipients along 5 years after LT. The influence of baseline variables on survival, morbidity and mortality was studied.
There was a continuous and significant increase of the prevalence of all the CV risk factors (except smoking) after LT. CV diseases were the fourth cause of mortality in the 5 years after LT, causing 12% of deaths during the follow-up. Most CV events (39%) occurred in the first year after LT.
Pre-existing CV risk factors such as age, pre-LT CV events, diabetes, metabolic syndrome and hyperuricemia, and mycophenolate-free immunosuppressive therapy, increased post-LT CV morbidity and mortality.
The development of new onset CV risk factors after LT, such as dyslipidemia and obesity, independently affected late CV morbidity and mortality. Tacrolimus and steroids increased the risk of post-transplant diabetes, while cyclosporine increased the risk of arterial hypertension dyslipidemia and metabolic syndrome.
Cardiovascular complications and CV mortality are frequent in LT recipients. Pre-existing CV risk factors, immunosuppressive drugs but also the early new onset of obesity and dyslipidemia after LT play an important role on late CV complications. A strict metabolic control in the immediate post-LT is advisable for improving CV risk of LT recipients. This article is protected by copyright. All rights reserved.
CITATION Liver Transpl. 2017 Feb 3. doi: 10.1002/lt.24738