Prevalence of Fatty Liver Disease Post-Liver Transplantation and Its Relationship to Cardiovascular Events

Abstract

Introduction: Cardiovascular disease (CVD) has emerged as a leading cause of non-graft related death in orthotopic liver transplantation (OLT) recipients. The presence of post-transplant diabetes, hypertension, and metabolic syndrome was found to be a risk factor for CVD. Non-alcoholic fatty liver disease (FLD) is considered an independent risk factor for CVD in the general population. The aims were to assess the prevalence of FLD post-OLT and its correlation with CV events. Methods: Patients who underwent OLT at our institution between 2000-2008 with at least 2-year follow-up data were included in the study. CV events post-OLT included acute coronary syndrome, CHF, ischemic stroke, peripheral artery disease, and arrhythmias. Chart review was done for post-OLT CV events, metabolic syndrome factors and FLD on imaging (US/CT/MRI) and/or liver biopsy. A univariable analysis was performed to assess differences between subjects with and without post-OLT FLD, plus a time-to-event analysis to examine the relationship of post-OLT FLD to CV events. The association of FLD with each of the CV outcomes of interest was evaluated via multivariable Cox regression analysis to adjust for potential confounders (p<0.05). Results: A total of 275 patients were included. Mean age at time of transplant was 53±12 years, 69% male, 81% white with mean BMI 28.3±5.8 kg/m2. Mean follow-up time post-OLT was 69±30 months. Most common indications for OLT in our sample were hepatitis C virus (35.9%), cryptogenic/ NASH cirrhosis (18.8%), and alcoholic liver disease (15.2%). Sixty-two subjects (23%) had evidence of FLD post-OLT. The 5-year overall cumulative risks of CV events were 13% and 6% for those with and without FLD post-OLT, respectively. Statistical analysis (Figure 1) showed no significant association between FLD and CV events (HR 1.8; 95% CI 0.64-5.3; p=0.26), major adverse CV events (MACE; HR 1.4; 95% CI 0.57-3.7; p=0.44), cardiac-related death (HR 0.70; 95% CI 0.11-4.5; p=0.70), or overall death (HR 1.5; 95% CI 0.84-2.7; p=0.17).Figure 1Conclusion: FLD is common after OLT affecting approximately one-quarter of patients. However, FLD was not associated with the development of CV events or cardiac-related death in this population.