Long-term survivors after pediatric liver transplatation are at increased risk for development of cardiovascular disease events: analysis of 30 cases.

Abstract

BACKGROUND:

Liver transplantation (LT) in adult patients is associated with a higher incidence of cardiovascular risk factors (CVRF), chronic kidney disease (CKD), and cardiovascular disease mortality than the general population. Available information about these problems in adult patients with LT from a pediatric age is limited. The aim of this study was to analyze the incidence of CVRF, risk of developing CKD, and risk of 10-year coronary event in adult patients who received LT in childhood.

METHODS:

Thirty adult patients (11 female, 19 male; mean age, 29.3 years) who underwent LT in childhood were analyzed, and CVRF, estimated glomerular filtration rate, and current immunosuppressive regimen were recordered. The risk of 10-year coronary event was calculated with the use of validated equations (Framingham and Regicor) and compared with the estimated risk in the general population.

RESULTS:

None of the patients had CVRF before LT, except 1 patient who received a transplant because of familial hypercholesterolemia. Median age of patients at the time of study was 28.6 years (range, 19.3-43.1 y), and mean follow-up after LT was 17.83 ± 5.21 years. Twenty-nine patients (96.7%) were receiving a calcineurin inhibitor (69% tacrolimus, 31% cyclosporine), along with steroids in 13 of them. The average CVRF per patient was 2, and 11 patients (43.33%) had ≥3. Thirteen patients (43.33%) had CKD. The estimated risk of developing a coronary event at 10 years according to the Framingham score was 3%, higher than expected in the general population of same age and sex. With the use of the Regicor equation, adapted to the Spanish population, the estimated cardiovascular risk was 1.6%, corresponding to Spanish men without CVRF aged 50-55 years. None of the patients had cardiovascular events during the follow-up.

CONCLUSIONS:

Our data show a high incidence of CVRF and CKD in young adults who received LT in childhood, resulting in an increased risk of cardiovascular disease.

• Authors: S de la Fuente, M J Citores, I Baños, A Duca, V Cuervas-Mons
• Journal: Transplantation proceedings (Transplant Proc) Vol. 46 Issue 9 Pg. 3111-3 (Nov 2014) ISSN: 1873-2623 [Electronic] United States
• PMID: 25420837 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Calcineurin Inhibitors
• Immunosuppressive Agents
• Cyclosporine
• Tacrolimus

Topics

• Adult
• Calcineurin Inhibitors (therapeutic use)
• Cardiovascular Diseases (epidemiology)
• Cyclosporine (therapeutic use)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Incidence
• Liver Transplantation
• Male
• Postoperative Complications (epidemiology)
• Risk Factors
• Survivors
• Tacrolimus (therapeutic use)
• Young Adult