Cumulative risk of cardiovascular events following orthotopic liver transplantation.
Liver Transpl. 2011 Dec 5. Epub 2011 Dec 5. PMID: 22140067
Department of Gastroenterology and Hepatology, Cleveland, Ohio, USA.
As post-orthotopic liver transplantation (OLT) survival improves, cardiovascular (CV) disease has emerged as the leading cause of non-graft related deaths. The aims of our study were to determine the cumulative risk of CV events post OLT and to analyze predictive risk factors for those experiencing a CV event post OLT. Methods: We identified all adult patients who underwent OLT at our institution for end-stage liver disease between January 1996 and July 2008. Cumulative risk of CV events after OLT was analyzed using Kaplan-Meier method. Multivariate logistic regression analysis was used to identify factors independently associated with CV events post OLT. Results: A total of 775 patients with OLT were included in our study cohort (mean age 53.3 + 6 years, 44% females, 84% Caucasian; median follow up, 40 months). Indications for OLT were hepatitis C virus (HCV) 36.1%, alcohol 19.3%, Non-alcoholic steatohepatitis (NASH) 18.1%, cryptogenic 4.8%, primary sclerosing cholangitis 3.6%, primary biliary cirrhosis 3.6%, and others 14.5%. Eighty-three patients suffered one or more CV events post OLT (acute coronary syndrome 35, congestive heart failure 18, stroke 9, arrhythmia 9, peripheral artery disease 8 and stable angina 4). Median time from OLT to initial cardiac event was 17.2 months. Post-transplant metabolic syndrome was more prevalent in patients with CV events than in those without (69.9% vs. 37.5%, P<0.001). By multivariate analysis independent predictors of CV events were older age at transplant [Odds ratio (OR):1.2(1.1-1.3), P = 0.006], male gender [OR:2.0(1.2-3.3), P = 0.01], post-transplant diabetes [OR:2.0(1.3-3.3), P = 0.003] and post-transplant hypertension [OR:1.8(1.1-3.0), P = 0.016]. Risk of CV events was higher in those transplanted for NASH and lower in those with PBC or PSC. Among post-OLT patients cumulative risk of CV events at 1, 3, and 5 years were 4.5%, 10.1%, and 13.5% respectively. CONCLUSION: Cardiac complications after liver transplantation are common (10% of patients experience>1 CVE within 3 years post OLT). Patients with post-transplant hypertension and diabetes, modifiable risk factors, are twice as likely to have a CV event. CV risk varies with etiology of liver disease, lower for cholestatic liver disease and higher for NASH. Future studies should look at validating these findings prospectively and determining if aggressive risk reduction of modifiable factors can decrease CV risk. © 2011 American Association for the Study of Liver Diseases.