Cardiovascular risk profile of patients with acute liver failure after liver transplantation when compared with the general population.
BACKGROUND
As opposed to most solid-organ transplant recipients, patients with acute liver failure exhibit a pretransplant health status more comparable with the general population, and any posttransplant cardiovascular risk excess should thus be more attributable to transplantation-related factors alone.


METHODS
This study compared the cardiovascular risk of 77 consecutive patients with acute liver failure at 5 years after liver transplantation with that of the general population using age, sex, and residence area-standardized prevalence ratios (SPR).


RESULTS
At least one cardiovascular risk factor developed in 92% of patients. Treated hypertension, observed in 71% of patients at 5 years, was more common among patients than controls (SPR, 2.73; 95% confidence interval [CI], 2.06-3.55), whereas the 61% prevalence of dyslipidemia and 3% prevalence of impaired fasting glucose were significantly less frequent among patients (SPR, 0.69; 95% CI, 0.51-0.92 and SPR, 0.29; 95% CI, 0.04-1.00). The 5-year prevalence of diabetes (10%), overweight (32%), and obesity (13%) deviated nonsignificantly from controls (SPR 1.90, 0.85, and 0.58). Antibody therapy associated with a 1.49-fold increase in the risk of hypertension (95% CI, 1.15-1.94) and a 6.43-fold increase in the risk of diabetes (95% CI, 1.18-34.9). Immunosuppression-type, steroids, acute rejection, retransplantation, or graft steatosis revealed nonsignificant risk alterations.


CONCLUSIONS
Liver transplantation and associated immunosuppression evidently cause hypertension, and possibly elicit diabetes in susceptible individuals. Conversely, the often reported transplantation-associated increased burden of overweight/obesity and dyslipidemia might relate mostly to other factors.
Aberg
Fredrik
F
Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland. Fredrik.Aberg@helsinki.fi
Jula
Antti
A
Höckerstedt
Krister
K
Isoniemi
Helena
H
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood; D017114:Liver Failure, Acute / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
D001786:Blood Glucose; D008055:Lipids