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. 2015 Dec;35(12):2575-83.
doi: 10.1111/liv.12872. Epub 2015 Jun 3.

Impact of renal impairment on cardiovascular disease mortality after liver transplantation for nonalcoholic steatohepatitis cirrhosis

Lisa B VanWagner  1   2   3 , Brittany Lapin  3   4 , Anton I Skaro  3   4 , Donald M Lloyd-Jones  1 , Mary E Rinella  2
Affiliations

Impact of renal impairment on cardiovascular disease mortality after liver transplantation for nonalcoholic steatohepatitis cirrhosis

Lisa B VanWagner et al. Liver Int. 2015 Dec.

Abstract

Background & aims: Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant.

Methods: Using the Organ Procurement and Transplantation Network database, we examined associations between NASH and post-liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction or stroke. A physician panel reviewed cause of death.

Results: Of 48 360 liver transplants (2/2002-12/2011), 5057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic and have history of renal failure or prior CVD vs. non-NASH (P < 0.001 for all). Although there was no difference in overall all-cause mortality (log-rank P = 0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio = 1.30, 95% Confidence interval (CI): 1.02-1.66; Hazard ratio = 1.42, 95% CI: 1.07-1.41 respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥55, male sex, diabetes and renal impairment was developed for prediction of post-liver transplant CVD mortality (c-statistic 0.60).

Conclusion: NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of comorbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality.

Keywords: NAFLD; NASH; fatty liver; heart disease; mortality.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Underlying cause of CVD-related mortality in 75 NASH recipients who died within 30 days of transplant
*Other = arrhythmia, ruptured aortic aneurysm, hypertensive crisis, pulmonary hypertension
Figure 2
Figure 2. Long-term CVD-related survival stratified by stage of chronic kidney disease as measured by glomerular filtration rate
Patients were censored at time of death or date of last follow up. Kaplan-Meier survival analysis, Log-rank, p<0.001 GFR, glomerular filtration rate, categories were defined as:

  1. >or= 90 (normal function) = 1

  2. 60–89 (stage 2 CKD) = 2

  3. 30–59 (stage 3 CKD) = 3

  4. 15–29 (stage 4 CKD) =4

  5. <15 or on renal replacement therapy at time of transplant (stage V CKD) =5

See this image and copyright information in PMC

References

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