title: Impact of Cardiovascular Risk Factors on Long-Term Mortality After Liver Transplantation.
abstract: Immunosuppression with calcineurin inhibitors has contributed to an increased prevalence of hypertension, diabetes, and hypercholesterolemia in patients receiving liver transplantation. This study evaluated the prevalence of cardiovascular risk factors, their management, and long-term mortality after liver transplantation. Medical records were reviewed in 333 adult patients who underwent orthotopic liver transplantation. Data were collected on medical diagnoses before and after transplantation, medication use, and on long-term mortality. The 333 patients in the study included 223 men and 110 women, mean age 59 ± 10 years. The mean follow-up was 50 ± 28 months. After transplantation, there was a high prevalence of hypertension (67%), hypercholesterolemia (46%), diabetes mellitus (42%), and chronic kidney disease (45%). Out of 333 patients in the study, 96 patients (29%) died during follow-up. Stepwise logistic regression was performed to identify the risk factors that might influence long-term mortality outcomes. Based on pretransplant characteristics, positive independent risk factors that increased mortality were age at transplant and hepatitis C. After transplantation, positive predictive factors were diabetes mellitus and cancer. A negative predictive risk factor for mortality was hypercholesterolemia. Analysis of medication after transplantation showed that positive predictive factors were the use of insulin, steroids, and antibiotics. Negative predictors for mortality were tacrolimus and mycophenolate. Our data suggest that diabetes mellitus and hepatitis C play an important role in worsening posttransplant mortality.
authors.affiliation: 1Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY; and 2Division of Gastroenterology and Hepatobiliary Disease, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.
authors.forename: Hoang M
authors.initials: HM
authors.lastname: Lai
authors.forename: Rahul
authors.initials: R
authors.lastname: Pawar
authors.forename: David C
authors.initials: DC
authors.lastname: Wolf
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors