Abstract 18429: Is Metabolic syndrome post Liver Transplantation a Risk Factor for Cardiovascular Disease?

Abstract

Introduction: Up to two-thirds of patients develop metabolic syndrome within five years post orthotopic liver transplant (OLT). Data on overall cardiovascular (CV) morbidity and mortality among OLT recipients, particularly those who develop metabolic syndrome, is limited and there are no specific guidelines on management of post OLT metabolic syndrome. Hypothesis: We assessed hypothesis that metabolic syndrome post OLT is associated with increased risk of CV events.

Methods: Historical cohort study of all adult patients who underwent OLT at our institution for end-stage liver disease between from year 1987 to year 2011.Symptoms or confirmed diagnosis of coronary artery disease (with or without interventions) and stroke were categorized as CV events. CV deaths included deaths due to CV events as well as those from arrhythmias and heart failure.

Results: From a total of 428 patients in our cohort (Male, 64%; Caucasian, 79.5%), more than half (55.8%) died in the follow-up period. Graft failure (17.9%), infection (21.4%) and CV disease (17.4%) were the top three causes of deaths. About one-third (30.3%) of patients had post transplant metabolic syndrome (DM, 46.9 %; mean HDL 40.6 +-16.7; mean triglycerides, 58.8 +_88.5; mean BMI, 29.04+_7.3). Patients with post transplant metabolic syndrome had higher incidence of myocardial infarction (14.3 % versus 3.7%, P 0.02) and overall CV events (73.4% versus 37.6%, P < 0.001) as compared to patients without metabolic syndrome. There was no difference in all-cause mortality (41.9 % versus 50%, P =0.56) or CV deaths (18.2% versus 13.3 %, P=0.79) between the two groups.

Conclusion: Metabolic syndrome after liver transplantation is associated with twice the risk of CV events and about four times the risk of myocardial infarction, as compared to patients without metabolic syndrome. This high risk group may potentially benefit from aggressive risk reduction strategies or modification of immunosuppressive regimen.