title: Frequency of Cardiovascular Events and Effect on Survival in Liver Transplant Recipients for Cirrhosis Due to Alcoholic or Nonalcoholic Steatohepatitis.
abstract: OBJECTIVE
  Frequency of liver transplants because of nonalcoholic steatohepatitis is increasing. Data are conflicting on nonalcoholic steatohepatitis as a risk factor for cardiovascular events after transplant.
  
  
  METHODS
  We reviewed medical records of liver transplant recipients (between years 2005 and 2010) for alcoholic cirrhosis or nonalcoholic steatohepatitis for cardiovascular events (arrhythmia, congestive heart failure, coronary disease, pulmonary hypertension, or stroke) and patient survival within 3 years.
  
  
  RESULTS
  Compared with the 65 transplant recipients for alcoholic cirrhosis, the 78 transplant recipients for nonalcoholic steatohepatitis were significantly (P < .0001 for all) more likely to be female (46% vs 8%), have a larger mean body mass index (34 ± 7 vs 29 ± 5), more likely to have diabetes (58% vs 26%), less likely to be hepatitis C virus-positive (3% vs 29%), and less likely to smoke (29% vs 69%). Eleven patients with nonalcoholic steatohepatitis and 9 patients with nonalcoholic steatohepatitis had cardiovascular events; however, these groups were not significantly different 1 year (7.7% vs 6.1%; P = .45) or 3 years (14.1% vs 13.8%; P = .9) after liver transplant. The odds of having a cardiovascular event were about 9-fold greater for patients with concomitant hepatitis C virus and 3-fold greater for men. Eighteen patients died, with patients with cardiovascular events having greater than 4-fold increased mortality (mean 4.1-fold; range, 1.2-fold to 13.9-fold).
  
  
  CONCLUSIONS
  Cardiovascular events occurred with similar frequency in transplant recipients for nonalcoholic steatohepatitis or alcoholic cirrhosis. Patient survival was affected in both groups, but male patients with concomitant hepatitis C virus infection remained at higher risk for a cardiovascular event after liver transplant. Development of a cardiac evaluation protocol for liver transplant recipients could help monitor these patients.
authors.affiliation: From the University of Alabama Medical School, University of Alabama, Birmingham, AL, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Piazza
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome