Cardiovascular assessment in liver transplant for non-alcoholic steatohepatitis patients: What we do, what we should do

Table 1 Methods to detect subclinical atherosclerosis[8]

Carotid ultrasound	CIMT	> 0.9 mm
CT coronary angiography	No. of calcifications in coronary arteries	≥ 1
Endothelial function	Flow-mediated vasodilation brachial artery
	Carotid-femoral pulse wave velocity	> 12 m/s
Morpho-structural alteration	Electrocardiogram (left ventricular hypertrophy)	Sokolov-Lyon > 38 mm; cornell > 2444 mm*ms
Renal function	Slight increase in plasmatic creatinine	M: 1.3-1.5 mg/dL
		F: 1.2-1.4 mg/dL
	Low glomerular filtration	Creatinine clearance < 60 mL/min
	Microalbuminuria	30-300 mg/24 h
		Alb/Cr ≥ 22 (M) or ≥ 31 (F) mg/g Cr
Inflammatory biomarkers	TNF, IL-6, C-reactive protein
Thrombogenic biomarkers	PAI-1, fibrinogen, factor VII

CIMT: Carotid intima-media thickness; CT: Computerized tomography; M: Male; F: Female; TNF: Tumor necrosis factor; IL: Interleukin; PAI-1: Plasminogen activator inhibitor type 1.

Table 2 Cardiovascular mortality in non-alcoholic fatty liver disease patients

Ref.	Year	NAFLD diagnosis	Follow-up	CV mortality	Cause of mortality
Dam-Larsen et al[48]	2004	Histology	20 yr	38%	1st
Adams et al[49]	2005	Histology	8 yr	25%	2nd
Ong et al[50]	2008	Ultrasound	9 yr	25%	1st
Rafiq et al[51]	2009	Histology	29 yr	13%	1st
Söderberg et al[52]	2010	Histology	28 yr	35%	1st
Angulo et al[53]	2013	Histology	9 yr	38%	1st
Stepanova et al[54]	2013	Histology	12 yr	28%	1st
Ekstedt et al[16]	2015	Histology	26 yr	43%	1st

CV: Cardiovascular; NAFLD: Non-alcoholic fatty liver disease.

Table 3 Immunosuppressive drugs and metabolic side effects affecting post-liver transplantation cardiovascular risk[33]

Drug	Group	Side effects
Corticosteroids		Dyslipidemia ++
		AHT +++
		DM +++
		Renal impairment -
Mycophenolate mofetil	De novo purine synthesis inhibitor	Dyslipidemia -
		AHT -
		DM -
		Renal impairment -
Cyclosporine	Calcineurin inhibitors	Dyslipidemia ++
Tacrolimus		AHT +++
		DM ++
		Renal impairment ++
Sirolimus	mTOR inhibitors	Dyslipidemia +++
Everolimus		AHT -
		DM -
		Renal impairment -

(+): Positive association; (-): No association; AHT: Arterial Hypertension; DM: Diabetes mellitus.