Prospective monitoring of cardiovascular risk factors in liver and kidney transplant recipients
Mitkovskaya N.P., Rummo O.O., Grigorenko E.A.
Keywords: liver, kidneys, cardiovascular risk, transplantation
DOI: 10.18087 / rhfj.2014.3.1923
Background. The importance of studying new risk factors (RFs) for cardiovascular complications in recipients of organ and tissue transplants is related with complicated monitoring of modifiable cardiovascular RFs in patients who have severe disabling organ injury at the stage of adding them to the waiting list and who acquire postoperative iatrogenic RFs after successful organ transplantation. Aim. To perform prospective monitoring of signs influencing structure and function cardiovascular parameters and cardiovascular risk in recipients of liver and kidney transplants at the stage of addition to the waiting list and during the postoperative period. Materials and methods. 164 patients of the Republican Center for Organ and Tissue Transplantation (Belarus) were evaluated, including 75 orthotopic liver transplant recipients and 89 kidney transplant recipients. The study was prospective and therefore implied enrollment of patients who had been already added to the waiting list. Structural and functional status of the cardiovascular system was studied and cardiometabolic risk markers and hemostasis system indices were measured in all liver and kidney transplant recipients. Results. Remote postoperative progression of LV hypertrophy was associated with increased coronary artery calcification. The major biochemical markers for the presence of endothelial dysfunction and myocardial stress were homocysteine level in the group of kidney transplant recipients and levels of von Willebrand factor and D-dimers in the group of liver transplant recipients. For stratification of cardiovascular risk in kidney transplant recipients, as distinct from the general population, measurement of NT-proBNP was uninformative in the remote postoperative period of kidney transplantation. Conclusion. Irrespective of the cardiovascular history, organ transplant recipients are at high risk of adverse cardiovascular events in the remote postoperative period as well as at addition to the waiting list, and they require aggressive drug correction of the risk despite the performed organ replacement therapy.
- Jackson SP, Nesbitt WS, Kulkarni S. Signaling events underlying thrombus formation. J Thromb Haemost. 2003 Jul;1 (7):1602–12.
- Moreno PR, Bernardi VH, López-Cuéllar J et al. Macrophages, smooth muscle cells, and tissue factor in unstable angina. Implications for cell-mediated thrombogenicity in acute coronary syndromes. Circulation. 1996 Dec 15;94 (12):3090–7.
- Rader DJ. Inflammatory markers of coronary risk. N Engl J Med. 2000;343 (16):1179–1182.
- Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med. 1999;340 (2):115–126.
- Оганов Р. Г. Иммуновоспалительные реакции при остром коронарном синдроме. Рациональная фармакотерапия в кардиологии. 2007;5:15–19.
- Cybulsky MI, Gimbrone MA Jr. Endothelial expression of a mononuclear leukocyte adhesion molecule during atherogenesis. Science. 1991 Feb 15;251 (4995):788–91.
Mitkovskaya N.P., Rummo O.O., Grigorenko E.A. Prospective monitoring of cardiovascular risk factors in liver and kidney transplant recipients. Russian Heart Failure Journal. 2014;84 (3):172–178