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

被引：56

作者：

D'Avola, Delia ^{[1
,2
]}

Cuervas-Mons, Valentin ^{[3
]}

Marti, Josep ^{[4
]}

Ortiz de Urbina, Jorge ^{[5
]}

Llado, Laura ^{[6
]}

Jimenez, Carlos ^{[7
]}

Otero, Esteban ^{[8
]}

Suarez, Francisco ^{[9
]}

Rodrigo, Juan M. ^{[10
]}

Gomez, Miguel-Angel ^{[11
]}

Fraga, Enrique ^{[12
]}

Lopez, Pedro ^{[13
]}

Trinidad Serrano, M. ^{[14
]}

Rios, Antonio ^{[15
]}

Fabrega, Emilio ^{[16
]}

Ignacio Herrero, Jose ^{[1
,2
]}

机构：

[1] Univ Navarra Clin, Liver Unit, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Pamplona, Spain

[2] Inst Invest Sanitaria Navarra IdiSNA, Pamplona, Spain

[3] Hosp Clin Puerta Hierro, Liver Transplantat, Internal Med, Madrid, Spain

[4] Hosp Clin Barcelona, Inst Malaties Digest & Metab, Inst Invest Biomed August Pi & Sunyer, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain

[5] Hosp Univ Cruces, Hepatobiliary Surg & Liver Transplantat Unit, Bilbao, Spain

[6] Hosp Univ Bellvitge, Bellvitge Inst Biomed Res, Liver Surg & Transplant Unit, Barcelona, Spain

[7] Hosp 12 Octubre, Dept Surg, Madrid, Spain

[8] Hosp Clin Univ Santiago de Compostela, Dept Internal Med, Abdominal Transplant Unit, Santiago De Compostela, Spain

[9] Hosp Univ A Coruna, Liver Transplant Unit, La Coruna, Spain

[10] Hosp Reg Univ Malaga, Dept Gastroenterol, Malaga, Spain

[11] Hosp Virgen del Rocio, Liver Transplant Unit, Seville, Spain

[12] Hosp Univ Reina Sofia, Dept Hepatol, Cordoba, Spain

[13] Hosp Ramon & Cajal, Dept Surg, Madrid, Spain

[14] Hosp Univ Lozano Blesa, Dept Gastroenterol, Liver Unit, Zaragoza, Spain

[15] Hosp Univ Virgen de la Arrixaca, Transplant Unit, Surg Serv, Murcia, Spain

[16] Hosp Univ Marques de Valdecilla, Gastroenterol & Hepatol Unit, Santander, Spain

来源：

LIVER TRANSPLANTATION | 2017年 / 23卷 / 04期

关键词：

SERUM URIC-ACID; NONALCOHOLIC STEATOHEPATITIS; CARDIAC DYSFUNCTION; BLOOD-PRESSURE; RENAL-FUNCTION; RISK; ALLOPURINOL; CYCLOSPORINE; TACROLIMUS; CIRRHOSIS;

D O I：

10.1002/lt.24738

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：498 / 509

页数：12

共 34 条

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