Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events

Abstract

Nonalcoholic steatohepatitis (NASH) is an independent predictor of coronary artery disease (CAD). Our aim was to compare the incidence of cardiovascular (CV) events between patients transplanted for NASH and alcohol (ETOH)-induced cirrhosis. This is a retrospective cohort study (August 1993 to March 2010) of 242 patients (115 NASH and 127 ETOH) with 12 months follow-up after liver transplantation (LT). Those with hepatocellular carcinoma or coexisting liver diseases were excluded. Kaplan-Meier's and Cox's proportional hazard analyses were conducted to compare survival. Logistic regression was used to calculate the likelihood of CV events, defined as death from any cardiac cause, myocardial infarction, acute heart failure, cardiac arrest, arrhythmia, complete heart block, and/or stroke requiring hospitalization <1 year after LT. Patients in the NASH group were older (58.4 versus 53.3 years) and were more likely to be female (45% versus 18%; P < 0.001). They were more likely to be morbidly obese (32% versus 9%), have dyslipidemia (25% versus 6%), or have hypertension (53% versus 38%; P < 0.01). On multivariate analysis, NASH patients were more likely to have a CV event <1 year after LT, compared to ETOH patients, even after controlling for recipient age, sex, smoking status, pretransplant diabetes, CV disease, and the presence of metabolic syndrome (26% versus 8%; odds ratio 5 4.12; 95% confidence interval 5 1.91-8.90). The majority (70%) of events occurred in the perioperative period, and the occurrence of a CV event was associated with a 50% overall mortality. However, there were no differences in patient, graft, or CV mortality between groups. Conclusions: CV complications are common after LT, and NASH patients are at increased risk independent of traditional cardiac risk factors, though this did not affect overall mortality. (HEPATOLOGY 2012;56:1741-1750

Untitled

“…Furthermore, death because of a cardiovascular event and the frequency of a cardiovascular event were analyzed. 16 When we pooled the data from the 3 studies, which including ours and 2 other studies, 11,17 and compared NASH recipients versus alcoholic cirrhosis recipients, the probability of a cardiovascular event-related mortality remained similar between the groups (16 of 264 patients vs 7 of 275 patients; mean, 2.3; range, 0.7-8.2; P = .19).…”

“…The relatively smaller sample size in our study and the higher proportion of patients with a history of pretransplant cardiovascular disease among NASH transplants in the other reported study may partly explain the differences in findings. 11 In a recently meta-analysis of 9 studies on 4237 patients who received a liver transplant for various liver diseases (717 NASH), no differences in patient survival at 1, 3, and 5 years was shown when transplant patients with NASH and without NASH were compared. However, the authors concluded that NASH patients died more often from cardiovascular causes than the other groups.…”

“…7,8 Although the association between liver disease and cardiovascular disease is well recognized, it remains unclear whether NASH is a predictor of a cardiac event after transplant. [9][10][11] Because metabolic syndrome is more persistent and more frequent in patients who undergo transplant for NASH-related cirrhosis versus those with other liver diseases, we hypothesized that causes related to NASH are a risk factor for cardiovascular events after liver transplant. To test this hypothesis, we compared patients who received liver transplants for NASH cirrhosis with patients who received liver transplants for alcoholic cirrhosis.…”

Farnesoid X Receptor Agonist as a new treatment option for Non-Alcoholic Fatty Liver disease: A Review

“…Liver transplantation is the only option left for NASH patients with cirrhosis. However, even after transplantation there is risk of recurrence of disease and cardiovascular complications [99].…”

Debate-a bridge too far: Nonalcoholic fatty liver disease will not exhaust the donor pool

“…12 In addition, even the highly selected NASH patients currently being transplanted have a higher rate of cardiovascular events compared with patients transplanted for other indications. 13,14 This has resulted in some advocating for combined liver transplantation and gastric sleeve resection.…”