Cardiovascular Disease Outcomes Related to Early Stage Renal Impairment After Liver Transplantation

Abstract

Even mild renal disease at the time of LT is a risk factor for posttransplant all-cause and CV mortality. More rapid declines in eGFR soon after LT correlate with risk of adverse CV outcomes, highlighting the need to study whether early renal preservation interventions also reduce CV complications.

Blood pressure control according to clinical practice guidelines is associated with decreased mortality and cardiovascular events among liver transplant recipients

“…The association between guideline‐concordant BP care and reduction in CVEs and all‐cause mortality was preserved among high‐risk patients, although these patients were actually less likely to receive guideline‐concordant care. Therefore, future guideline updates for LTRs should focus on the importance of broad application of the guidelines and inclusion of patients with comorbidities, particularly those with CKD and diabetes, who are arguably at highest risk for adverse CV outcomes . The major questions arising from our results are (a) whether the difference in mortality or CVE between LTRs with controlled and uncontrolled BP reflects a true association between the delivery of guideline‐concordant care and a durable morbidity and mortality benefit, (b) whether BP control is merely a marker of healthier patients, or (c) whether it is a marker of those receiving better overall post‐LT care.…”

International Liver Transplantation Consensus Statement on End-stage Liver Disease Due to Nonalcoholic Steatohepatitis and Liver Transplantation

“…Renal dysfunction in this setting is multifactorial due to other comorbidities (hypertension, DM) but also related to the severity of liver disease. Importantly, renal dysfunction is a risk factor for posttransplant CV disease and mortality 71,72 . Even mild renal disease at the time of LT has been shown in one study to be a risk factor for posttransplant allcause and CV mortality 72 .…”

“…Importantly, renal dysfunction is a risk factor for posttransplant CV disease and mortality 71,72 . Even mild renal disease at the time of LT has been shown in one study to be a risk factor for posttransplant allcause and CV mortality 72 . In one study, more rapid declines in estimated glomerular filtration rates (eGFR) soon after LT correlated with risk of adverse CV outcomes, highlighting the need to study whether early renal preservation interventions also reduce CV complications 72 .…”

Area Under Trough Concentrations of Tacrolimus as a Predictor of Progressive Renal Impairment After Liver Transplantation

“…Among LT patients, chronic kidney disease is per se a major cause of excess of death as compared with age-matched general population, 19 but it also has an indirect morbidity effect by increasing the risk of cardiovascular events. 20 The prevalence, prognostic impact and complex management of chronic kidney disease after LT have motivated several consensus documents aiming to delineate strategies in order to prevent or at least to ameliorate this complication. 3,21,22 The etiology of renal impairment after LT is multifactorial, being abnormal pre-transplant renal function the most powerful risk factor.…”