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World J Gastroenterol. Oct 28, 2016; 22(40): 8869-8882
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8869
Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study
Giuseppina Pisano, Anna L Fracanzani, Lucio Caccamo, Maria F Donato, Silvia Fargion
Giuseppina Pisano, Anna L Fracanzani, Silvia Fargion, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca’ Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy
Lucio Caccamo, Unit of Hepatic Surgery, Department of Pathophysiology and Transplantation, Ca’ Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy
Maria F Donato, Division of Gastroenterology, Department of Pathophysiology and Transplantation, Ca’ Granda IRCCS Foundation, Policlinico Hospital, University of Milan, 20122 Milan, Italy
Author contributions: All authors contributed to this paper; Pisano G, Fracanzani AL and Fargion S contributed to study concept, literature review and analysis, drafting of the manuscript and critical revision; Caccamo L and Donato MF contributed to acquisition and analysis of patients data; all authors approved the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anna L Fracanzani, MD, Unit of Internal Medicine, Department of Pathophysiology and Transplantation, Ca’ Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Via F. Sforza 35, 20122 Milan, Italy. anna.fracanzani@unimi.it
Telephone: +39-255-033370 Fax: +39-250-320296
Received: June 29, 2016
Peer-review started: June 30, 2016
First decision: August 8, 2016
Revised: August 27, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: October 28, 2016
Processing time: 119 Days and 3.9 Hours
Abstract

Improved surgical techniques and greater efficacy of new anti-rejection drugs have significantly improved the survival of patients undergoing orthotopic liver transplantation (OLT). This has led to an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality in OLT patients. In the last decade, several studies have examined which predisposing factors lead to increased cardiovascular risk (i.e., age, ethnicity, diabetes, NASH, atrial fibrillation, and some echocardiographic parameters) as well as which factors after OLT (i.e., weight gain, metabolic syndrome, immunosuppressive therapy, and renal failure) are linked to increased cardiovascular mortality. However, currently, there are no available data that evaluate the development of atherosclerotic damage after OLT. The awareness of high cardiovascular risk after OLT has not only lead to the definition of new but generally not accepted screening of high risk patients before transplantation, but also to the need for careful patient follow up and treatment to control metabolic and cardiovascular pathologies after transplant. Prospective studies are needed to better define the predisposing factors for recurrence and de novo occurrence of metabolic alterations responsible for cardiovascular damage after OLT. Moreover, such studies will help to identify the timing of disease progression and damage, which in turn may help to prevent morbidity and mortality for cardiovascular diseases. Our preliminary results show early occurrence of atherosclerotic damage, which is already present a few weeks following OLT, suggesting that specific, patient-tailored therapies should be started immediately post OLT.

Keywords: Orthotopic liver transplant; Cardiovascular risk; Atherosclerosis, Non-alcoholic fatty liver disease; Intima-media thickness; Epicardial fat thickness; Diastolic dysfunction

Core tip: Due to better immunosuppressive therapies, the survival of liver transplantation recipients is improved, but an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality is observed. This review analyzes risk factors [before orthotopic liver transplantation (OLT) and occurring de novo after OLT] leading to cardiovascular diseases and the current tools to identify high risk patients. We also provide preliminary data from one of the first prospective studies on the evolution of cardiovascular damage in adult patients submitted to OLT.