Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study

Abstract

Improved surgical techniques and greater efficacy of new anti-rejection drugs have significantly improved the survival of patients undergoing orthotopic liver transplantation (OLT). This has led to an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality in OLT patients. In the last decade, several studies have examined which predisposing factors lead to increased cardiovascular risk (i.e., age, ethnicity, diabetes, NASH, atrial fibrillation, and some echocardiographic parameters) as well as which factors after OLT (i.e., weight gain, metabolic syndrome, immunosuppressive therapy, and renal failure) are linked to increased cardiovascular mortality. However, currently, there are no available data that evaluate the development of atherosclerotic damage after OLT. The awareness of high cardiovascular risk after OLT has not only lead to the definition of new but generally not accepted screening of high risk patients before transplantation, but also to the need for careful patient follow up and treatment to control metabolic and cardiovascular pathologies after transplant. Prospective studies are needed to better define the predisposing factors for recurrence and de novo occurrence of metabolic alterations responsible for cardiovascular damage after OLT. Moreover, such studies will help to identify the timing of disease progression and damage, which in turn may help to prevent morbidity and mortality for cardiovascular diseases. Our preliminary results show early occurrence of atherosclerotic damage, which is already present a few weeks following OLT, suggesting that specific, patient-tailored therapies should be started immediately post OLT.

Keywords: Orthotopic liver transplant, Cardiovascular risk, Atherosclerosis, Non-alcoholic fatty liver disease, Intima-media thickness, Epicardial fat thickness, Diastolic dysfunction

Core tip: Due to better immunosuppressive therapies, the survival of liver transplantation recipients is improved, but an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality is observed. This review analyzes risk factors [before orthotopic liver transplantation (OLT) and occurring de novo after OLT] leading to cardiovascular diseases and the current tools to identify high risk patients. We also provide preliminary data from one of the first prospective studies on the evolution of cardiovascular damage in adult patients submitted to OLT.