Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil.
Cardiovascular (CV) diseases are recognized longterm causes of death after liver transplantation (LT). The objective of this multicenter study was to analyze the prevalence and the evolution of CV risk factors and CV morbidity and mortality in 1819 LT recipients along 5 years after LT. The influence of baseline variables on survival, morbidity, and mortality was studied. There was a continuous and significant increase of the prevalence of all the CV risk factors (except smoking) after LT. CV diseases were the fourth cause of mortality in the 5 years after LT, causing 12% of deaths during the follow-up. Most CV events (39%) occurred in the first year after LT. Preexisting CV risk factors such as age, pre-LT CV events, diabetes, metabolic syndrome, and hyperuricemia, and mycophenolate-free immunosuppressive therapy, increased post-LT CV morbidity and mortality. The development of new-onset CV risk factors after LT, such as dyslipidemia and obesity, independently affected late CV morbidity and mortality. Tacrolimus and steroids increased the risk of posttransplant diabetes, whereas cyclosporine increased the risk of arterial hypertension, dyslipidemia, and metabolic syndrome. In conclusion, CV complications and CV mortality are frequent in LT recipients. Preexisting CV risk factors, immunosuppressive drugs, but also the early new onset of obesity and dyslipidemia after LT play an important role on late CV complications. A strict metabolic control in the immediate post-LT period is advisable for improving CV risk of LT recipients. Liver Transplantation 23 498-509 2017 AASLD.
Liver Unit, Clinica Universidad de Navarra, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
Delia
D
D'Avola
Liver Transplantation, Internal Medicine, Hospital Clínica Puerta de Hierro, Madrid, Spain.
Valentín
V
Cuervas-Mons
Institut de Malaties Digestives i Metabòliques, Hospital Clinic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Josep
J
Martí
Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario de Cruces, Bilbao, Spain.
Jorge
J
Ortiz de Urbina
Liver Surgery and Transplant Unit, Hospital Universitari de Bellvitge, Bellvitge Institute for Biomedical Research, Barcelona, Spain.
Laura
L
Lladó
Department of Surgery, Hospital 12 de Octubre, Madrid, Spain.
Carlos
C
Jimenez
Department of Internal Medicine, Abdominal Transplant Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Esteban
E
Otero
Liver Transplant Unit, Hospital Universitario de A Coruña, A Coruña, Spain.
Francisco
F
Suarez
Gastroenterology Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
Juan M
JM
Rodrigo
Liver Transplant Unit, Hospital Virgen del Rocío, Sevilla, Spain.
Miguel-Angel
MA
Gómez
Department of Hepatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
Enrique
E
Fraga
Department of Surgery, Hospital Ramón y Cajal, Madrid, Spain.
Pedro
P
Lopez
Department of Gastroenterology, Liver Unit, Hospital Universitario Lozano Blesa, Zaragoza, Spain.
M Trinidad
MT
Serrano
Transplant Unit, Surgery Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Antonio
A
Rios
Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Emilio
E
Fábrega
Liver Unit, Clinica Universidad de Navarra, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
José Ignacio
JI
Herrero
D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D050171:Dyslipidemias / Q000150:complications; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D066027:Transplant Recipients
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus