Research ArticleRisk factors for arterial hypertension after liver transplantation
Introduction
In the last decades, the development of new surgical techniques and targeted immunosuppressive treatments has improved the outcome of cirrhotic patients undergoing liver transplantation (LT), with a reduction of intraoperative and perioperative mortalities, graft failure, and acute organ rejection. The overall survival of LT recipients is estimated to be 81%–97% at 1 year,1, 2 56%–80.6% at 5 years,3, 4 and 52%–72% at 10 years after LT.1, 5, 6 Nevertheless, metabolic comorbidities, including arterial hypertension, diabetes mellitus, and dyslipidemia, have increased in cirrhotic patients after LT,7, 8, 9, 10, 11 and new onset of cardiovascular (CV) events has significantly affected the overall prognosis of these patients. In North American populations, CV mortality ranges from 2% to 24% within the first year,6, 12, 13 from 7% to 16% after 5 years,3, 6, 14, 15 and 13% after 10 years from LT.16, 17 In this study, we have analyzed the prevalence of arterial hypertension before and after LT in patients recruited in the Liver Transplant Center of the University of Turin, in an effort to identify metabolic comorbidities and immunosuppressive therapies that may be related to new-onset hypertension after LT in previously normotensive (NT) patients.
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Methods
This study is a retrospective evaluation of a consecutive series of 359 Caucasian cirrhotic patients who underwent LT at the Liver Transplant Center of the University of Turin, Italy from January 1, 2008 to December 1, 2012 and were followed up until January 1, 2015. The design of the study is summarized in Figure 1. Pediatric patients (younger than 18 years), intraoperative deaths, and patients without at least two follow-up visits (n = 36) were excluded, and 323 subjects were considered for
Baseline Evaluation
At baseline, 323 cirrhotic patients (24.1% females) were considered with a mean age at the transplantation of 53.4 ± 9.3 years and Child-Pugh and MELD scores of 10.9 ± 1.4 and 17.6 ± 7.6, respectively (Table 1). Hepatitis C virus (HCV) infection was the most frequent cause of cirrhosis in the global population; 11 patients underwent a second LT because of acute graft failure: six for graft hepatic artery thrombosis, two for biliary complications, two for HCV recurrence, and one for
Discussion
This study analyzed different BP patterns in LT recipients, considering the different timings of the onset of arterial hypertension and metabolic complications. In our cohort, the prevalence of arterial hypertension increased from 15.2% to 52.9% after LT in line with previously published studies8, 11, 21, 22, 23, 24, 25; we noted a high incidence of transient hypertension after LT (15.2%), a finding previously described in a small cohort of 32 subjects.22
Transient hypertension is related to
Conclusion
In NT LT recipients, the development of arterial hypertension after LT is a frequent finding; in a group of previously NT subjects, about 15% will develop a transient and 36% a sustained arterial hypertension.
The sustained arterial hypertension may be related to immunosuppressive regimen with mTORi, development of hepatic steatosis and alcoholic cirrhosis. Tacrolimus was not correlated with development of transient hypertension, suggesting a safe profile as first-line immunosuppressive
Acknowledgments
C.D.S. wrote the manuscript and was responsible for the analysis and interpretation of data with V.M.; V.B., E.N., E.M., and R.Y. were responsible for acquisition of data; A.M., E.V., and S.M. were responsible for the conception and design of the study; S.M. and A.M. drafted the article and revised it critically for important intellectual contents; and R.R., M.S., and F.V. gave the final approval of the version to be submitted.
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Grant support: This study did not receive grants or financial support.
Conflict of interest: None.