Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time

Abstract

Major adverse cardiovascular events (MACEs) are the leading cause of early (<1 y) complications after liver transplantation (LT). NASH, the leading indication for waitlisting for LT, is associated with high cardiac risk factor burden. The contemporary prevalence and temporal trends in pretransplant cardiac risk factor burden and post-LT MACE among LT recipients (LTRs) with and without NASH are unknown. The aim of this study was to evaluate (1) the evolution of post-LT cardiac risk factors in LTRs over time and (2) post-LT MACE over time, stratified by NASH status. This is a retrospective cohort of 1775 adult LTRs at a single transplant center (2003–2020). MACE was defined as death or hospitalization from myocardial infarction, revascularization, stroke, heart failure during the first post-LT year. Between 2003 and 2020, there was a significant increase in pre-LT NASH (p trend <0.05). There was also a significant increase in pre-LT obesity, atherosclerotic cardiovascular (CV) disease, and older age (≥65 y old) (p trend<0.05 for all). There was no significant change in the proportion of LTRs with diabetes, chronic kidney disease, or heart failure. Unexpectedly, there were no changes in the rate of post-LT MACE over the study period (−0.1% per year, p trend=0.44). The lack of change in MACE despite an increase in CV risk factor prevalence may reflect advancement in the identification and management of CV risk factors in LTRs. With projected continued increase in cardiac risk burden and the proportion of patients transplanted for NASH, it is critical for LT programs to develop and implement quality improvement efforts to optimize CV care in LTRs.

How best to combine liver transplantation and bariatric surgery?—Results from a global, web‐based survey

“…Abdominal obesity does not necessarily correlate with a high BMI, what may weaken this numeric score as only risk stratification to surgery. In addition, patients with BMI over 35 kg/m 2 usually present with a cluster of comorbidities, particularly cardiovascular diseases and T2DM, which may both affect vessel quality and increase the postoperative risk for cardiovascular events 43,44 . In contrast to NAFLD, patients with MAFLD present with the highest cumulative incidence of cardiovascular disease‐related and other cause‐related mortality in 15 years 45 …”

“…In addition, patients with BMI over 35 kg/m 2 usually present with a cluster of comorbidities, particularly cardiovascular diseases and T2DM, which may both affect vessel quality and increase the postoperative risk for cardiovascular events. 43,44 In contrast to NAFLD, patients with MAFLD present with the highest cumulative incidence of cardiovascular disease-related and other cause-related mortality in 15 years. 45 This general clinical experience is also supported by the findings in our survey, where a third of respondents conduct a specific and extended preoperative workup for patients with NASH and obesity in contrast to the 'standard' LT workup for non-obese candidates.…”

Physical activity in liver transplant recipients: a large multicenter study

“…At the same time, after LT, patients develop metabolic alterations with high incidence of obesity, type II diabetes, hypertension, hyperlipidaemia and metabolic syndrome (MS) [ 6 ]. As a consequence, LT recipients show higher rates of cardiovascular (CV) events in comparison to the general population [ 7 ]. In particular, up to 58% of LT recipients develop CV risk factors or MS [ 8 ], which are mainly due to immunosuppressant drugs and unhealthy lifestyle [ 9 , 10 ].…”

Physical activity in liver transplant recipients: a large multicenter study

“…At the same time, soon after LT, patients develop metabolic alterations with high incidence of obesity, type II diabetes, hypertension, hyperlipidaemia and metabolic syndrome [6]. As a consequence, LT recipients show higher rates of cardiovascular (CV) events in comparison to the general population [7]. In particular, up to 58% of LT recipients develop CV risk factors or metabolic syndrome [8], which are mainly due to immunosuppressant drugs and unhealthy lifestyle [9,10].…”