Paolo Maggi, Federica Calò, Vincenzo Messina, Gianfranca Stornaiuolo, Maria Stanzione, Luca Rinaldi, Stefania De Pascalis, Margherita Macera, Nicola Coppola
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality after liver transplantation, mostly in patients transplanted for nonalcoholic steatohepatitis, obesity and diabetes. Few data exist on cardiovascular diseases among patients transplanted for viral hepatitis.
Introduction
Liver transplantation (LT) is a lifesaving procedure for patients with acute and chronic end stage liver disease, and hepatocellular carcinoma [1–3].
Hepatotrophic viruses capable of causing chronic hepatitis (i.e. hepatitis C virus, hepatitis B virus and hepatitis D virus) are among the most common causes of cirrhosis and a frequent indication for liver transplantation, in particular among individuals with co-infections who are at increased risk of end stage liver disease.
Nowadays, LT is a routine procedure with excellent outcomes in terms of quality and length of life. However, complications are frequent both in the early and long-term period, and significantly impact in terms of morbidity and mortality [4–8]. In particular, cardiovascular complications and metabolic alterations among liver transplant recipients, represent, the main early and late complications during follow-up [9].
Materials and methods
This is a cross-sectional, observational cohort study including patients with orthotopic liver transplantation (OLT) consecutively admitted for routine follow-up visit to the Infectious Disease outpatient facilities of the University of Campania Luigi Vanvitelli, Naples, Italy from June 2019 to September 2020.
All adult (age ≥ 18 years) patients with liver transplantation due to viral hepatitis who signed informed consent were included; therefore, liver transplant recipients due to other etiologies were excluded.
The study was approved by the Ethics Committee of the Hospital of Campania Luigi Vanvitelli. All procedures in the study protocol were carried out in accordance with the Helsinki Declaration of 1975. Written consent was obtained.
Results
The demographic and clinical characteristics of enrolled patients are summarized in Table 1. Of the 161 patients with a history of OLT evaluated in the study period, 15 were excluded because not affected by viral hepatitis; thus, an overall of 146 patients were enrolled in the present study (median age 64 years; males 73.9%), of whom 59 (40.4%) were transplanted for HCV, 27 (18.4%) for HBV, 46 (31.5%) for dual infection HBV-HDV, 10 (6.8%) for dual infection HBV-HCV and 4 (2.7%) for triple infection HBV-HDV-HCV end-stage liver disease. For 87 patients (59.5%) the time since transplantation was greater than 10 years, while only 23 (15.6%) patients had been transplanted for less than 5 years.
Discussion
Cardiovascular disease has emerged as the leading cause of non-graft-related deaths [28, 29]. In fact, LT represents a major stress which can affect and worsen preexisting cardiovascular dysfunctions [9, 12], mostly in early post-transplant follow-up. Studies concerning long-term cardiovascular complications are fewer than those focused on early morbidity.
The risk of CVD in liver transplant recipients is due to several mechanisms: aging, systemic hemodynamic changes due to advanced liver disease, chronic inflammation and immunosuppressive treatment.
Citation: Maggi P, Calò F, Messina V, Stornaiuolo G, Stanzione M, Rinaldi L, et al. (2022) Cardiovascular disease risk in liver transplant recipients transplanted due to chronic viral hepatitis. PLoS ONE 17(3): e0265178. https://doi.org/10.1371/journal.pone.0265178
Editor: Vanessa Carels, PLoS ONE, UNITED STATES
Received: May 15, 2021; Accepted: February 25, 2022; Published: March 16, 2022
Copyright: © 2022 Maggi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript.
Funding: The authors received no specific fundings for this work.
Competing interests: NO authors have competing interests.
