Cardiovascular risk factors in liver allograft recipients: relationship with immunosuppressive therapy

Varó, Evaristo; Padin, Esther Mariño; Otero, Esteban; Tomé, Santiago; Castroagudı́n, J.F.; Delgado, Marcial; Conde, Rosa; Segade, F.R.; Mella, C; González‐Quintela, Arturo

doi:10.1016/s0041-1345(02)03018-x

Cited by 22 publications

(6 citation statements)

References 4 publications

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“…Our study did not find the use of tacrolimus to be an independent risk factor for de novo post-transplant diabetes. Our results are consistent with several reports in the literature (36)(37)(38)(39)(40), which show similar rates of de novo diabetes in patients receiving tacrolimus and cyclosporine. However, in other studies the use of tacrolimus was associated with increased risk of diabetes (19,21,41,42).…”

Section: Discussionsupporting

confidence: 93%

Prevalence and Risk Factors for Diabetes Mellitus in Moderate Term Survivors of Liver Transplantation

Saab

Shpaner

Zhao

et al. 2006

American Journal of Transplantation

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The prevalence and risk factors for diabetes mellitus after liver transplantation are not well understood. Thus, we sought to identify independent risk factors for the development of diabetes after liver transplantation using currently accepted medical criteria.We studied the prevalence and risk factors in 253 adult recipients transplanted at UCLA between January 1998 and December 2002. Analysis of the retrospective data was performed using demographic, immunosuppression and liver disease variables. Factors found to be significant on a univariate analysis were further studied in a multivariate analysis. There were 158 men and 95 women in our study. The mean age was 51.4 ± 11.0 years. The mean [± standard deviation (SD) pretransplant body mass index was 26.7 (±5.1). Most patients were transplanted for hepatitis C (HCV). The prevalence of diabetes after transplantation was 17.8%. In a multivariate analysis only gender [odds ratio (OR) = 0.37; p = 0.02] was independently predictive of the development of diabetes.This study in a large liver transplant recipient population identifies male gender as an independent risk factor for the development of diabetes. Follow-up studies are needed to assess the impact of diabetes, and its intervention on post-transplant morbidity and mortality.

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Section: Discussionsupporting

confidence: 93%

Prevalence and Risk Factors for Diabetes Mellitus in Moderate Term Survivors of Liver Transplantation

Saab

Shpaner

Zhao

et al. 2006

American Journal of Transplantation

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“…Coincident with the elevations in blood pressure, more anti-hypertensive agents were required by patients in the cyclosporine group through all 3 years of follow-up. The prevalence of hypertension in cyclosporine-treated patients is consistent with evidence in the literature both from the United Network for Organ Sharing (UNOS) database as cited above and from single-center studies (5,6,23).…”

Section: Discussionsupporting

confidence: 84%

“…Our data show that, despite comparable baseline serum creatinine levels in the two treatment groups, patients receiving cyclosporine demonstrated significantly higher levels of serum creatinine and a greater change in serum creatinine (delta serum creatinine) compared with the tacrolimus cohort at all time points following transplantation. Similar results have been reported by two independent groups (6,23).…”

Section: Number Of Patients At Each Follow-upsupporting

confidence: 92%

A Comparison of Tacrolimus and Cyclosporine in Liver Transplantation: Effects on Renal Function and Cardiovascular Risk Status

Lucey

Abdelmalek

Gagliardi

et al. 2005

American Journal of Transplantation

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A retrospective chart review of 1065 consecutive liver allograft recipients in 11 centers from January 1997 to September 1998 was performed. Patients were followed for 3 years or until graft loss. Patients received either tacrolimus (n = 594), cyclosporine (n = 450) or no calcineurin inhibitor (n = 21). Model for end-stage liver disease (MELD) scores at time of transplant were similar between the two groups. During follow-up, more patients switched from cyclosporine to tacrolimus (26.7%) than from tacrolimus to cyclosporine (12.8%; p < 0.0001). Patient and graft survival were equivalent. Corticosteroid use was more common in cyclosporine-treated patients (p < 0.00001). Patients receiving tacrolimus experienced lower serum creatinine levels at months 3 through 36 (p < 0.0001). Systolic blood pressure was lower in patients receiving tacrolimus (p < 0.001) despite a reduced requirement for anti-hypertensive agents (p < 0.0001). In addition, tacrolimus was associated with lower total cholesterol and triglyceride levels for months 3 through 24 and 3 through 12, respectively (p < 0.01), despite a reduced requirement for anti-hyperlipidemic agents. The incidence of new-onset diabetes mellitus was similar in both groups. While both calcineurin inhibitors were associated with excellent patient and graft survival, renal function, blood pressure and serum lipid levels were significantly better with tacrolimus treatment.

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“…Even though cardiovascular disease has not been detected among pediatric LT recipients, atherosclerosis precedes target organ damage and detrimental clinical outcomes by decades 31, 32. Current immunosuppressive medications are well known to predispose patients to potent atherosclerosis risk factors, including diabetes, hyperlipidemia, hypertension, renal disease, and obesity 33–36. It seems inevitable that premature cardiovascular events will add substantially to the disease burden of pediatric LT recipients over time.…”

Section: Long‐term View Of the Lt Allograft And Recipientmentioning

confidence: 99%

Long-term outcomes in pediatric liver transplantation

Bucuvalas

2009

Liver Transpl

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Key Points 1. Critical clinical outcomes for pediatric liver transplantation (LT) recipients include (1) patient and graft survival, (2) complications (immune and nonimmune) of chronic immunosuppressive medications, and (3) long-term graft function. 2. Recurrence of malignancy, sepsis, and posttransplant lymphoproliferative disorder account for more than 65% of deaths occurring more than 1 year after LT. 3. Chronic rejection, late hepatic artery thrombosis, and biliary strictures account for 70% of graft loss occurring more than 1 year after LT. 4. Late histological changes in the allograft are emerging as a common problem in patients more than 5 years after LT. The pathogenesis of these findings and the impact on graft survival remain to be determined. Liver Transpl 15: S6-S11, 2009.Liver transplantation (LT) is the standard of care for children with end-stage, irreversible liver disease. The best outcomes occur when pediatric LT recipients maintain graft function while immune and nonimmune complications related to immunosuppressive medications are minimized. Patient survival, graft survival, and graft function, including biliary and vascular complications, infections, and posttransplant hepatitis and fibrosis, are critical outcomes. It is also essential to acknowledge and address issues related to nonimmune complications of immunosuppression (specifically renal, cardiovascular, and cancer risk). 1,2 PATIENT AND GRAFT SURVIVAL FROM THE TIME OF LISTING FOR LTApproximately 88% of patients less than 18 years old who are listed for transplantation ultimately undergo LT (Fig. 1). A subgroup of patients is removed from the waiting list because of improvements in the underlying condition or because transplantation is considered futile, and a similar proportion of patients die while on the waiting list. Within the first 90 days after LT, 5% to 7% die, and another 5% of patients undergo retransplantation. By the end of 3 years, about 65% of those originally listed for LT are alive with their primary transplant.3-6 No significant differences in graft and patient survival are detected when patients are grouped by age (Figs. 2 and 3); this reflects, at least in part, the significant improvements in operative techniques and innovations in the use of technical variant organs that have occurred over recent years. To target areas for further research, it makes sense to first identify causes for allograft loss and patient death. LATE ALLOGRAFT LOSS AND LATE DEATHWallot et al.7 described the outcomes of 376 patients from a single center who underwent primary LT between 1984 and 1998 and who survived more than 3 months after LT. Immunosuppression varied over time, consisting initially of cyclosporine, prednisone, and azathioprine and ultimately of tacrolimus and dual or triple therapy. The 1-, 5-, and 10-year actuarial graft survival rates were 94.6%, 87.3%, and 86

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Cardiovascular risk factors in liver allograft recipients: relationship with immunosuppressive therapy

Cited by 22 publications

References 4 publications

Prevalence and Risk Factors for Diabetes Mellitus in Moderate Term Survivors of Liver Transplantation

Prevalence and Risk Factors for Diabetes Mellitus in Moderate Term Survivors of Liver Transplantation

A Comparison of Tacrolimus and Cyclosporine in Liver Transplantation: Effects on Renal Function and Cardiovascular Risk Status

Long-term outcomes in pediatric liver transplantation

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