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Understanding and managing cardiovascular outcomes in liver transplant recipients

Izzy, Manhala; VanWagner, Lisa B.b; Lee, Samuel S.d; Altieri, Marioe; Angirekula, Mounikac; Watt, Kymberly D.c

Current Opinion in Organ Transplantation: April 2019 - Volume 24 - Issue 2 - p 148–155
doi: 10.1097/MOT.0000000000000614
LIVER TRANSPLANTATION: Edited by Sophoclis P. Alexopoulos
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Purpose of review Cardiovascular disease (CVD) is a common cause of mortality after liver transplantation. The transplant community is focused on improving long-term survival. Understanding the prevalence of CVD in liver transplant recipients, precipitating factors as well as prevention and management strategies is essential to achieving this goal.

Recent findings CVD is the leading cause of death within the first year after transplant. Arrhythmia and heart failure are the most often cardiovascular morbidities in the first year after transplant which could be related to pretransplant diastolic dysfunction. Pretransplant diastolic dysfunction is reflective of presence of cirrhotic cardiomyopathy which is not as harmless as it was thought. Multiple cardiovascular risk prediction models have become available to aid management in liver transplant recipients.

Summary A comprehensive prevention and treatment strategy is critical to minimize cardiovascular morbidity and mortality after liver transplant. Weight management and metabolic syndrome control are cornerstones to any prevention and management strategy. Bariatric surgery is an underutilized tool in liver transplant recipients. Awareness of ‘metabolic-friendly’ immunosuppressive regimens should be sought. Strict adherence to the cardiology and endocrine society guidelines with regard to managing metabolic derangements post liver transplantation is instrumental for CVD prevention until transplant specific recommendations can be made.

aDivision of Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee

bDivision of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

cDivision of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA

dDivision of Hepatology, Caen University, Caen, France

eLiver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Correspondence to Manhal Izzy, Assistant Professor of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University School of Medicine, 1660 The Vanderbilt Clinic, Nashville, TN 37232, USA. Tel: +1 615 322 0128; e-mail: Manhal.izzy@vumc.org

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