Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

Abstract

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.

Fatty allograft and cardiovascular outcomes after liver transplantation

“…Although studies have suggested mycophenolate mofetil to be associated with increased risk of CVD after transplant, this finding in retrospective studies was thought to reflect high‐risk individuals being treated with mycophenolate mofetil to lower doses of calcineurin inhibitors. A recent study found the opposite, with lower CV risk associated with mycophenolate mofetil use . Further prospective studies will be needed to clarify this finding.…”

“…A recent study found the opposite, with lower CV risk associated with mycophenolate mofetil use. (30) Further prospective studies will be needed to clarify this finding. Mammalian target of rapamycin inhibitors have a theoretical benefit to atherosclerotic vascular disease, given its use in stent covering, but no data demonstrating a benefit in CV events after transplant have been published (Fig.…”

Assessment of sarcopenia, hepatic function and clinical outcomes in liver transplantation

“…[202][203][204] However, post-transplant obesity is more prevalent than in the general population and is independently associated with post-transplant metabolic syndrome (PTMS) and cardiovascular disease. 205,206 Post-transplant cardiovascular disease is a significant problem, as highlighted by D'Avola et al who found it was the fourth highest cause of 5year mortality in a large cohort of Spanish liver transplant recipients. 206 Early diagnosis and intervention of cardio-metabolic risk factors post-transplant has been proposed to counteract the risk of cardiovascular disease.…”

“…205,206 Post-transplant cardiovascular disease is a significant problem, as highlighted by D'Avola et al who found it was the fourth highest cause of 5year mortality in a large cohort of Spanish liver transplant recipients. 206 Early diagnosis and intervention of cardio-metabolic risk factors post-transplant has been proposed to counteract the risk of cardiovascular disease. 207 To help predict post-transplant metabolic complications, some authors have examined pretransplant variables and found the presence of pre-transplant obesity to be a strong predictor of PTMS, along with diabetes and dyslipidaemia.…”

“…Cardiovascular disease (CVD) after liver transplantation is associated with increased morbidity and mortality. 205,206 In a large cohort of Spanish transplant recipients, CVD was the fourth highest cause of 5 year mortality, accounting for 12% of deaths. 206 diabetes mellitus, dyslipidaemia and obesity.…”