Does Atherosclerosis Progress Faster After Liver Transplant? A Comparative Study and Analysis of Progression Risk Factors.

BACKGROUND: Cardiovascular disease (CVD) is thought to evolve faster after liver transplantation (LT) due to an increased prevalence of cardiovascular risk (CVR) factors and the use of immunosuppression. The progression of coronary artery calcium score (CACS) in computed tomography is a prognostic biomarker of CVD. There is scarce information about CACS changes after LT or in patients with cirrhosis. METHODS: We compared the 5-year progression of CACS in two populations: 75 LT recipients and 20 patients with cirrhosis assessed for LT but who eventually did not undergo LT (non-LT). In both populations, CACS was measured at LT evaluation and 5 years thereafter. Additionally, we studied 1-year post-LT CVR factors and immunosuppression parameters, including cumulative exposure to tacrolimus (CET) as potential predictors of 5-year CACS progression after LT. RESULTS: Both groups were comparable regarding CVR factors, time between CACS, or baseline CACS. CACS increased in both groups, with an annualized progression of 23 Agatston units (AU)/year in LT and 30 AU/year in non-LT (p = 0.833). CVR factors control after LT was optimal, and 80% received standard/minimized CET. Higher pre-LT CACS (p < 0.001) and worse kidney function 12 months after transplantation (p = 0.003) independently predicted progression after LT. No immunosuppression-related variables were associated with CACS progression. CONCLUSION: In LT recipients with optimized control of CVR factors and standard/minimized CET, CACS progression was not faster than in patients with cirrhosis. The association between posttransplant renal function and CACS progression warrants further investigation.