Alfredo Caturano (1), Anna di Martino (1), Gaetana Albanese (1), Carmine Coppola (2), Raffaele Marfella (3), Ferdinando Carlo Sasso (3), Teresa Salvatore (4)
(1) Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy, (2) Area Stabiese Hospital, Naples, Italy, (3) Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy., (4) Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
Introduction: Death from cardiovascular disease (CVD) is described as the main cause of early mortality after orthotopic liver transplantation (OLT), followed by infection, and graft failure. The metabolic factors implicated in the increased cardiovascular risk in OLT patients have not been unequivocally elucidated. Among these, glucose homeostasis changings could play a key role that is not always easy to interpret. Therefore, we aimed at evaluating the significance of glucose homeostasis changings as predictor of cardiovascular events in OLT recipients.
Methods: We retrospectively evaluated 93 consecutive non-diabetic adult OLT recipients attending every three/six month (or more often when needed), from January 1995 to December 2020 and for at least two years after intervention. We collected anamnestic, clinical, anthropometric and laboratory parameters data.
Results: 93 eligible patients (median age 57 years [IQR: 49-62], 69.9% male) were followed for a median of 100.5 months (IQR: 51.1-205.6) after liver transplantation. During the follow-up, 29 patients (31.2%) developed a worsening glucose homeostasis (28 diabetic patients and 1 impaired fasting glucose). 14 patients developed at least one adverse CV event, 5 in the stable glycaemic group and 9 in the worsening glucose homeostasis group (7.8% vs. 31.0%; P=0.004). The Kaplan-Meier analysis showed a worse CV event-free survival in patients with worsening glucose homeostasis compared to those with stable glucose homeostasis (log rank: 0.046). Univariable COX regression analysis showed that worsening glucose homeostasis, BMI and waist circumference in the pre-OLT were associated with cardiovascular risk.
Conclusions: Worsening glucose homeostasis, BMI and waist circumference in the pre-OLT emerged as a predictor of cardiovascular risk in a cohort of adult OLT recipients.
