Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

Autor: Miguel-Angel Gómez, Esteban Otero, Valentín Cuervas-Mons, Enrique Fraga, Juan Rodrigo, Pedro López, José Ignacio Herrero, Emilio Fábrega, Josep Martí, Carlos Jimenez, Laura Lladó, Delia D'Avola, Francisco Suárez, Antonio Ríos, M. Trinidad Serrano, Jorge Ortiz de Urbina
Rok vydání: 2017
Předmět:
Graft Rejection
Male
medicine.medical_treatment
030230 surgery
Liver transplantation
Severity of Illness Index
Postoperative Complications
0302 clinical medicine
Risk Factors
Prevalence
Prospective Studies
Hyperuricemia
Prospective cohort study
Metabolic Syndrome
Age Factors
Middle Aged
Cardiovascular Diseases
Hypertension
Cyclosporine
Female
030211 gastroenterology & hepatology
Immunosuppressive Agents
Adult
medicine.medical_specialty
Tacrolimus
End Stage Liver Disease
03 medical and health sciences
Diabetes mellitus
Internal medicine
medicine
Humans
Aged
Dyslipidemias
Transplantation
Hepatology
business.industry
Mycophenolic Acid
medicine.disease
Survival Analysis
Obesity
Transplant Recipients
Liver Transplantation
Surgery
Diabetes Mellitus
Type 1
Spain
Metabolic syndrome
business
Dyslipidemia
Follow-Up Studies
Zdroj: Liver Transplantation. 23:498-509
ISSN: 1527-6473
1527-6465
Popis: Cardiovascular (CV) diseases are recognized longterm causes of death after liver transplantation (LT). The objective of this multicenter study was to analyze the prevalence and the evolution of CV risk factors and CV morbidity and mortality in 1819 LT recipients along 5 years after LT. The influence of baseline variables on survival, morbidity, and mortality was studied. There was a continuous and significant increase of the prevalence of all the CV risk factors (except smoking) after LT. CV diseases were the fourth cause of mortality in the 5 years after LT, causing 12% of deaths during the follow-up. Most CV events (39%) occurred in the first year after LT. Preexisting CV risk factors such as age, pre-LT CV events, diabetes, metabolic syndrome, and hyperuricemia, and mycophenolate-free immunosuppressive therapy, increased post-LT CV morbidity and mortality. The development of new-onset CV risk factors after LT, such as dyslipidemia and obesity, independently affected late CV morbidity and mortality. Tacrolimus and steroids increased the risk of posttransplant diabetes, whereas cyclosporine increased the risk of arterial hypertension, dyslipidemia, and metabolic syndrome. In conclusion, CV complications and CV mortality are frequent in LT recipients. Preexisting CV risk factors, immunosuppressive drugs, but also the early new onset of obesity and dyslipidemia after LT play an important role on late CV complications. A strict metabolic control in the immediate post-LT period is advisable for improving CV risk of LT recipients. Liver Transplantation 23 498-509 2017 AASLD.
Databáze: OpenAIRE
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