Vascular events after liver transplantation: a long-term follow-up study

Abstract

Summary Long‐term follow‐up studies on the impact of vascular events (VE) and risk factors of liver transplant recipients are scarce. In this study, 311 recipients of a first isolated liver transplant who survived at least 1 year were followed up from 1979 to 2002. The median follow‐up duration was 6.2 (range1–22.7) years. Overall median survival was 18.7 [95% confidence interval (CI): 15.5–20.1] years and this was significantly lower compared with age‐ and sex‐matched controls. Eleven (21%) of the patients had a vascular cause of death and VE were the third cause of death. VE occurred later compared with other causes of death (mean 10.3 years vs. 4.5 years, P < 0.0001, 95% CI: 2.7–8.9). Systolic hypertension, systolic blood pressure, smoking, renal failure, age, hypertriglyceridemia, serum total cholesterol levels and hypercholesterolemia at the 1‐year follow‐up visit were associated with the occurrence of VE, but renal failure and age at 1 year after transplantation were the only independent risk factors for vascular death (hazard ratio 0.06, 95% CI: 0.01–0.41 and hazard ratio 1.17, 95% CI: 1.02–1.34, respectively). Finally, it was shown that the adequate treatment of hypertension was associated with a significant reduced risk of vascular death. Therefore, vascular risk factors should be treated aggressively to prevent VE in the long term.

Risk factors of lung, head and neck, esophageal, and kidney and urinary tract carcinomas after liver transplantation: The effect of smoking withdrawal

“…Other complications associated with smoking are increased risks of infection,19 hepatic artery thrombosis and stenosis,20 and biliary complications 21. Furthermore, smoking is also a risk factor for cardiovascular disease,19, 22 and this is one of the most frequent causes of late mortality after liver transplantation 6. With this scenario, if the findings of this article are confirmed in larger series, all liver transplant candidates should be counseled against smoking.…”

Incidence of and Risk Assessment for Adverse Cardiovascular Outcomes After Liver Transplantation

“…Five studies had patient cohorts with limited representativeness compared to the overall patient population of interest and 1 study only provided limited data regarding the patient cohort. 14,19,24,33–35 Among the cardiac imaging studies, 2 studies were assessed as having limited representativeness given the inclusion and exclusion criteria. 20,30 …”

The effect of smoking on biliary complications following liver transplantation

“…Their work indicates an increased risk of overall, cardiovascular‐specific, and sepsis‐specific mortality with smoking [40]. Other recent studies have demonstrated that smoking is associated with inferior long‐term cardiovascular and oncologic outcomes following liver transplantation [2,4,5,41–44]. With regard to perioperative outcomes, smoking was also associated with increased resource utilization and hospital charges following liver transplantation in a series of 65 liver transplants over a 2‐year period at the University of Kentucky [45].…”