Cardiovascular disease outcomes related to early stage renal impairment after liver transplantation
Open accessAbstract
BACKGROUND: In the general population, even mild renal disease is associated with increased cardiovascular (CV) complications. Whether this is true in liver transplant recipients (LTR) is unknown. METHODS: This was a retrospective cohort study of 671 LTR (2002-2012) from a large urban tertiary care center and 37 322 LTR using Vizient hospitalization data linked to the United Network for Organ Sharing. The 4-variable Modification of Diet in Renal Disease equation estimated glomerular filtration rate (eGFR). Outcomes were 1-year CV complications (death/hospitalization from myocardial infarction, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, or stroke) and mortality. Latent mixture modeling identified trajectories in eGFR in the first liver transplantation (LT) year in the 671 patients. RESULTS: Mean (SD) eGFR was 72.1 (45.7) mL/min per 1.73 m. Six distinct eGFR trajectories were identified in the local cohort (n = 671): qualitatively normal-slow decrease (4% of cohort), normal-rapid decrease (4%), mild-stable (18%), mild-slow decrease (35%), moderate-stable (30%), and severe-stable (9%). In multivariable analyses adjusted for confounders and baseline eGFR, the greatest odds of 1-year CV complications were in the normal-rapid decrease group (odds ratio, 10.6; 95% confidence interval, 3.0-36.9). Among the national cohort, each 5-unit lower eGFR at LT was associated with a 2% and 5% higher hazard of all-cause and CV-mortality, respectively (P < 0.0001), independent of multiple confounders. CONCLUSIONS: Even mild renal disease at the time of LT is a risk factor for posttransplant all-cause and CV mortality. More rapid declines in eGFR soon after LT correlate with risk of adverse CV outcomes, highlighting the need to study whether early renal preservation interventions also reduce CV complications.
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Liver transplant recipients with T2D and chronic kidney disease are at the highest risk for cardiovascular events.
“Cardiovascular complications are the second most common cause of non-hepatic mortality in liver transplant recipients, 512 and those with T2D 513 and chronic kidney disease 514 are at the highest risk for cardiovascular events.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [514]
The Discussion (page unavailable) reports that lower kidney function after liver transplantation is associated with higher cardiovascular risk, supporting the CKD portion attributed to citation 514. But the Results identify recipients with a rapid decline from initially normal kidney function—not recipients with CKD generally—as having the greatest odds of cardiovascular complications. T2D is attached to a separate citation and is not judged here. (LLM, conf=0.88)
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Ayyala-Somayajula, D., & Terrault, N. A. (2026) · Wiley eBooks · doi:10.1002/9781394360031.ch41
- Authors
- VanWagner, L. B., Montag, S., Zhao, L., Allen, N. B., Lloyd-Jones, D. M., Das, A., Skaro, A. I., Hohmann, S., Friedewald, J. J., & Levitsky, J.
- Affiliations
- Northwestern University (US)
- Western University (CA)
- Corresponding author
- Levitsky, Josh
- ORCID
- Venue
- Transplantation
- Published
- 2018-07
- Volume
- 102
- Issue
- 7
- Pages
- 1096-1107
- ISSN
- 0041-1337 (ISSN-L)
- PMC
- PMC6023752
- OpenAlex
- W2789778816
- Cited by
- 32
- References
- 50
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 2
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Transplantation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (KL2TR001424, UL1TR001422, KL2TR000107)
- National Institute on Aging (R21AG049385)
- National Heart, Lung, and Blood Institute (F32HL116151, K23HL136891)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Keywords
- liver transplantation, cardiovascular complications, estimated glomerular filtration rate, post-transplant mortality, cardiovascular mortality, myocardial infarction, heart failure, atrial fibrillation
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Creatinine, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Liver Transplantation, Renal Insufficiency, End Stage Liver Disease
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