title: Plasma total homocysteine and cardiovascular risk in patients submitted to liver transplantation.
abstract: Patients submitted to orthotopic liver transplantation (OLT) show an increased rate of cardiovascular events. OLT subjects have high homocysteine (Hcy) levels, but no data are available on the association of Hcy with cardiovascular events. In a cross-sectional analysis, 230 subjects were studied at least 6 months after OLT (159 on cyclosporine, 71 on tacrolimus). Routine laboratory data and total Hcy were recorded, as well as the history of diabetes, hypertension, dyslipidemia, and overweight. Cardiovascular events occurring in a follow-up of 2-36 months were registered. OLT subjects had higher-than-normal Hcy (median 16.7 micromol/L, range 6.1-171.8) without difference between the 2 immunosuppressive agents. The prevalence of Hcy >15 micromol/L was also similar, and significantly correlated with creatinine levels. A total of 28 arterial events occurred in 25 patients during follow-up (11 in coronary arteries, 10 in peripheral arteries, and 7 in splanchnic arteries). Deep vein thromboses occurred in 2 patients, and splanchnic vein thromboses in 4 patients. Cardiovascular events were frequently associated to high Hcy and hypertension. Cox regression analysis showed that high Hcy was significantly associated with arterial events. The risk of any arterial event, coronary artery or peripheral artery event increased by nearly 10% for any increase in Hcy of 5 micromol/L. In conclusion, high Hcy may be involved in the pathogenesis of cardiovascular events in OLT patients. The usefulness of Hcy-lowering therapy remains to be verified.
authors.affiliation: Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. bianmice@almadns.unibo.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolino
authors.forename: Giorgia
authors.initials: G
authors.lastname: Passerini
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Paola
authors.initials: P
authors.lastname: Zappoli
authors.forename: Romina
authors.initials: R
authors.lastname: Graziani
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Raffaela
authors.initials: R
authors.lastname: Chianese
authors.forename: Vilma
authors.initials: V
authors.lastname: Mantovani
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011300:Preoperative Care; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014181:Transplantation Immunology / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D006710:Homocysteine