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Challenges and Controversies in Liver Transplantation
Cumulative risk of cardiovascular events after orthotopic liver transplantation†
Article first published online: 24 FEB 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 18, Issue 3, pages 370–375, March 2012
How to Cite
Albeldawi, M., Aggarwal, A., Madhwal, S., Cywinski, J., Lopez, R., Eghtesad, B. and Zein, N. N. (2012), Cumulative risk of cardiovascular events after orthotopic liver transplantation. Liver Transpl, 18: 370–375. doi: 10.1002/lt.22468
This study was supported by the Mikati Foundation (Beirut, Lebanon) through Nizar N. Zein.
- Issue published online: 24 FEB 2012
- Article first published online: 24 FEB 2012
- Accepted manuscript online: 5 DEC 2011 02:49AM EST
- Manuscript Accepted: 3 OCT 2011
- Manuscript Received: 14 JUN 2011
As survival after orthotopic liver transplantation (OLT) improves, cardiovascular (CV) disease has emerged as the leading cause of non–graft-related deaths. The aims of our study were to determine the cumulative risk of CV events after OLT and to analyze predictive risk factors for those experiencing a CV event after OLT. We identified all adult patients who underwent OLT at our institution for end-stage liver disease between October 1996 and July 2008. The cumulative risk of CV events after OLT was analyzed with the Kaplan-Meier method. Multivariate logistic regression analysis was used to identify factors independently associated with CV events after OLT. In all, 775 patients were included in our study cohort (mean age of 53.3 years, female proportion = 44%, Caucasian proportion = 84%, median follow-up = 40 months). The most common indications for OLT were hepatitis C virus (33.2%), alcohol (14.5%), and cryptogenic cirrhosis (12.7%). Eighty-three patients suffered 1 or more CV events after OLT. Posttransplant metabolic syndrome was more prevalent in patients with CV events versus patients with no CV events (61.4% versus 34.1%, P < 0.001). According to a multivariate analysis, independent predictors of CV events were an older age at transplantation [odds ratio (OR) = 1.2, addition of 95% confidence interval (CI) = 1.1-1.3, P = 0.006], male sex (OR = 2.0, 95% CI = 1.2-3.3, P = 0.01), posttransplant diabetes (OR = 2.0, 95% CI = 1.3-3.3, P = 0.003), posttransplant hypertension (OR = 1.8, 95% CI = 1.1-3.0, P = 0.02), and mycophenolate mofetil (OR = 2.0, 95% CI = 1.3-3.2, P = 0.003). Among post-OLT patients, the cumulative risk at 5 years of 13.5%, respectively. In conclusion, cardiac complications after liver transplantation are common (Approximately 10% of patients experience 1 or move cv events). Patients with posttransplant hypertension and diabetes, which are modifiable risk factors, are approximately twice as likely to experience a CV event. Liver Transpl 18:370–375, 2012. © 2012 AASLD.