Control of Blood Pressure in Liver Transplant Recipients

Martinez-Saldivar, B.; Prieto, J.; Berenguer, Marina; Mata, Manuel de la; Pons, J; Serrano, Trinidad; Rafael-Valdivia, L.; Aguilera, Victoria; Barrera, Pilar; Parrilla, Pascual; Lorente, Sara; Rubín, Ángel; Fraga, Enrique; Rimola, Antoni

doi:10.1097/tp.0b013e31824cd5e6

Cited by 22 publications

(14 citation statements)

References 38 publications

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“…Another important finding of this study is that all the CV risk factors assessed, except tobacco use, showed a continuous increase during the follow‐up that is evident since the first 6 months after LT. Notably, in accordance with other reports, the control of diabetes, dyslipidemia, and arterial hypertension worsened during the 5 years after LT . Despite the relatively short follow‐up of this series that may not allow us to fully capture the longterm impact of the new‐onset CV risk factors on late CV morbidity, this study revealed that the development of new‐onset CV risk factors may modify the CV risk in the first 5 years after transplantation.…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 85%

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

et al. 2017

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“…57,58 The molecular mechanism has not been fully elucidated, but it appears to involve intracellular oxidative stress, dysregulation of cytokines, inhibition of insulin downstream signaling, and reduced expression of glucose transporters. [59][60][61] Furthermore, it has long been noted that HCV infection may cause mixed cryoglobulinemia and immunemediated glomerulonephritis, 62,63 which can progress to renal failure. Because the presence of atherosclerosis in the peripheral artery may indicate a more diffuse process, this finding suggests that the pathogenic role of HCV is limited during the early phase of atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients

Maira

Rubín²,

Puchades³

et al. 2015

Liver Transpl

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Cardiovascular (CV) events represent major impediments to the long-term survival of liver transplantation (LT) patients. The aim of this study was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT cardiovascular events (CVEs). Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors, and CVEs occurring after LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, and peripheral arterial disease) were recorded. In total, 250 patients (69.6% men) with a median age of 56 years (range, 18-68 years) were included. At transplantation, 34.4%, 34.4%, and 33.2% of patients, respectively, had a low, moderate, and high FRS with a median FRS of 14.9 (range, 0.09-30); 14.4% of LT recipients developed at least 1 CVE at a median of 2.619 years (range, 0.006-6.945 years). In the univariate analysis, factors associated with the development of CVEs were the continuous FRS at LT (P 5 0.003), age (P 5 0.007), creatinine clearance [estimated glomerular filtration rate (eGFR); P 5 0.020], and mycophenolate mofetil use at discharge (P 5 0.011). In the multivariate analysis, only the eGFR [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.97-1.00; P 5 0.009] and FRS (HR, 1.06; 95% CI, 1.02-1.10; P 5 0.002) remained in the model. Moreover, an association was also found between the FRS and overall survival (P 5 0.004) with 5-year survival rates of 82.5%, 77.8%, and 61.4% for the low-, moderate-, and high-risk groups, respectively. Continuous FRS, eGFR, and hepatitis C virus infection were independent risk factors for overall mortality. In our series, the FRS and eGFR at LT were able to predict the development of post-LT CVEs and poor outcomes. Liver Transpl 21:812-822, 2015. V C 2015 AASLD.

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“…Interestingly, we recently published a multicenter Spanish study on control of blood pressure hypertension in almost 1000 LT recipients and we found that almost one‐third of the patients known to be hypertensive have an inadequate control of their blood pressure. Another remarkable result in our study was that 25% of patients never diagnosed as hypertensive after transplantation had increased blood pressure at the time of the study.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of ‘long-term liver transplant survivors’

Rubín¹,

Sánchez-Montes

Aguilera³

et al. 2013

Transpl Int

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SummaryThere are few studies focusing on long-term complications in liver transplant (LT) recipients. The aim of this study was to define the outcome of LT recipients having survived at least 10 years from LT. Of 323 adult LT done between 1991 and 1997, the 167(52%) alive >10 years post-LT (baseline time) formed the study population. Long-term outcome measures included the following: immunosuppression, metabolic complications [obesity, arterial hypertension (AH), diabetes, dislypidemia], cardiovascular events (CVE), chronic renal dysfunction-CRD, and de novo tumors. Median age at LT was 50 years. Most common indication was postnecrotic cirrhosis (89%), mostly because of HCV (46%). At study-baseline (10 years post-LT), 29% were obese and AH, diabetes, dislypidemia, and CRD were present in 75%, 30%, 42%, and 36%, respectively. In most cases, these complications were already present 1 year post-LT; less than one quarter developed them onward. The 6 year cumulative survival since baseline reached 84% (n = 24 deaths), with most deaths related to recurrent graft diseases (mostly HCV) followed by de novo tumors or CVE. 1, 3, 5 and 10 years cumulative rates of CVE and de novo tumors since baseline were 2%, 5%, 10% and 17%, and 1%, 3%, 6% and 13%, respectively. Chronic renal impairment was independently associated with survival and development of CVE since baseline. The medium-term survival of 'long-term survivors', i.e. patients alive 10 years after LT is good, but metabolic complications and CRD are common and continue to increase afterwards. Cardiovascular events and de novo tumors increase gradually over time and represent a major cause of late mortality.

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Control of Blood Pressure in Liver Transplant Recipients

Abstract: BP is not adequately controlled in a noticeable percentage of liver transplant patients, especially in subjects with diabetes or metabolic syndrome.

Cited by 22 publications

References 38 publications

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

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

Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients

Long-term outcome of ‘long-term liver transplant survivors’

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