Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study.
Improved surgical techniques and greater efficacy of new anti-rejection drugs have significantly improved the survival of patients undergoing orthotopic liver transplantation (OLT). This has led to an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality in OLT patients. In the last decade, several studies have examined which predisposing factors lead to increased cardiovascular risk (i.e., age, ethnicity, diabetes, NASH, atrial fibrillation, and some echocardiographic parameters) as well as which factors after OLT (i.e., weight gain, metabolic syndrome, immunosuppressive therapy, and renal failure) are linked to increased cardiovascular mortality. However, currently, there are no available data that evaluate the development of atherosclerotic damage after OLT. The awareness of high cardiovascular risk after OLT has not only lead to the definition of new but generally not accepted screening of high risk patients before transplantation, but also to the need for careful patient follow up and treatment to control metabolic and cardiovascular pathologies after transplant. Prospective studies are needed to better define the predisposing factors for recurrence andde novooccurrence of metabolic alterations responsible for cardiovascular damage after OLT. Moreover, such studies will help to identify the timing of disease progression and damage, which in turn may help to prevent morbidity and mortality for cardiovascular diseases. Our preliminary results show early occurrence of atherosclerotic damage, which is already present a few weeks following OLT, suggesting that specific, patient-tailored therapies should be started immediately post OLT.
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy.
Giuseppina
G
Pisano
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy.
Anna L
AL
Fracanzani
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy.
Lucio
L
Caccamo
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy.
Maria F
MF
Donato
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy.
Silvia
S
Fargion
D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016031:Liver Transplantation; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
Atherosclerosis, Non-alcoholic fatty liver disease; Cardiovascular risk; Diastolic dysfunction; Epicardial fat thickness; Intima-media thickness; Orthotopic liver transplant