E. Grigorenko, A. Shalimova, O. Rummo, N. Mitkovskaya
Belarusian State Medical University, Republican Scientific and Practical Center “Cardiology”, Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology, Minsk
Liver transplant is known to be the only radical treatment for patients with end-stage liver diseases. It is known that cardiovascular diseases rank third among patients, who underwent liver transplant. Due to the current generally accepted policy of aggressive treatment of hypercholesterolemia, mortality from cardiovascular diseases has been significantly reduced in general population. Statin therapy has also demonstrated a decreasing effect on mortality among patients with chronic liver failure. Recently published research results have shown the increasing occurrence of non-communicable diseases among liver recipients, including diseases that determine cardiovascular mortality (arterial hypertension, chronic coronary syndrome, chronic heart failure, chronic kidney failure). This evidence demonstrates that in post-operative period doctors should do their best to identify not only traditional risk factors of acute transplant rejection, but also pay attention to cardiovascular risks and their timely treatment. Based on the data about a number of differences in the incidence of cardiovascular risk factors and on the specifics of confirmation and treatment of chronic coronary heart disease in liver transplant recipients in comparison with the general population, we believe that in transplant centers it is necessary to develop a specialized algorithm of dispensary follow-up of recipients (checklist) for adequate prevention of diseases of the circulatory system.
ключевые слова: end-stage liver disease, liver transplant, hypolipidemic therapy, cardiovascular risk assessment
для цитирования: E. Grigorenko, A. Shalimova, O. Rummo, N. Mitkovskaya. Dyslipidemia in liver transplant recipients. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2021, vol. 5, no. 2, pp. 1270–1273
References
1. Klinicheskij protokol transplantacii pecheni [Clinical protocol for liver transplantation]: Prilozhenie 6 k prikazu Ministerstva zdravoohraneniya Respubliki Belarus 05.01.2010 № 6. (in Russian).
2. EASL clinical practice guidelines. Liver transplantation. J Hepatol, 2016, vol. 64(2), pp. 433-485. doi: 10.1016/j.jhep.2015.10.006.
3. Grigorenko E.A., Rummo O.O., Mitkovskaya N.P. Prognosticheskaya ocenka posttransplantacionnoj vyzhivaemosti recipientov transplantatov pecheni [Prognostic assessment of posttransplantation survival of liver transpant recipients]. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski, 2017, vol. 1, no. 1, pp. 72–77. (in Russian).
4. Watt K.D.S., Pedersen R.A., Kremers W.K., Heimbach J.K., Charlton M.R. Evolution of Causes and Risk Factors for Mortality Post-Liver Transplant: Results of the NIDDK Long-Term Follow-Up Study: Long-Term Mortality Post-Liver Transplant. Am J Transplant, 2010, vol. 10, no. 6, pp. 1420–1427.
5. Desai S., Hong J.C., Saab S. Cardiovascular risk factors following orthotopic liver transplantation: predisposing factors, incidence and management. Liver Int, 2009, vol. 30, no. 7, pp. 948-957. doi: 10.1111/j.1478-3231.2010.02274.x.
6. Trotter J.F., Wachs M.E., Trouillot T.E., Bak T., Kugelmas M., Kam I., Everson G. Dyslipidemia during sirolimus therapy in liver transplant recipients occurs with concomitant cyclosporine but not tacrolimus. Liver Transpl, 2001, vol. 7(5), pp. 401–408.
7. Neff G.W., Montalbanoa M., Tzakisa A.G. Ten years of sirolimus therapy in orthotopic liver transplant recipients. Transplant Proc, 2003, vol. 35(3Suppl), pp. 209s–216s.
8. Mells G., Neuberger J. Reducing the risks of cardiovascular disease in liver allograft recipients. Transplantation, 2007, vol. 83(9), pp. 1141–1150.
9. Kobashigawa J.A., Kasiske B.L. Hyperlipidemia in solid organ transplantation. Transplantation, 1997, vol. 63(3), pp. 331–338.
10. Patel S.S., Rodriguez V.A., Siddiqui M.B., Faridnia M., Lin F.P., Chandrakumaran A., Laurenzano J., Clinton J., Kowlgi G.N., Kirkman D., Sima A.P., Liptrap E., Bhati C., Siddiqui M.S. The impact of coronary artery disease and statins on survival after liver transplantation. Liver Transpl, 2019, vol. 25(10), pp. 1514–1523.
11. Chou R., Dana T., Blazina I., Daeges M., Jeanne T.L. Statins for prevention of cardiovas-cular disease in adults: evidence report and systematic review for the US preventive services task force. JAMA, 2016, vol. 316(19), pp. 2008-2024. doi: 10.1001/jama.2015.15629.
12. Athyros V.G., Tziomalos K., Gossios T.D., Griva T., Anagnostis P., Kargiotis K., Pagourelias E.D., Theocharidou E., Karagiannis A., Mikhailidis D.P. et al. Safety and efficacy of longterm statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet, 2010, vol. 376(9756), pp. 1916–1922.
13. Blais P., Lin M., Kramer J.R., El-Serag H.B., Kanwal F. Statins are underutilized in patients with nonalcoholic fatty liver disease and dyslipidemia. Dig Dis Sci, 2016, vol. 61(6), pp. 1714–1720.
14. De Luca L., Kalafateli M., Bianchi S., Alasaker N., Buzzetti E., Rodríguez-Perálvarez M., Thorburn D., O’Beirne J., Patch D., Leandro G., Westbrook R., Tsochatzis E.A. Cardiovascular morbidity and mortality is increased post liver transplantation even in recipients with no preexisting risk factors. Liver Int, 2019, vol. 39(8), pp. 1557–1565.
15. VanWagner L.B., Harinstein M.E., Runo J.R., Darling C., Serper M., Hall S., Kobashigawa J.A., Hammel L.L. Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: an evaluation of the evidence and consensus recommendations. Am J Transplant, 2018, vol. 18(1), pp. 30–42.
16. Mohanty A., Tate J.P., Garcia-Tsao G. Statins are associated with a decreased risk of decompensation and death in veterans with hepatitis C-related compensated cirrhosis. Gastroenterology, 2016, vol. 150(2), pp. 430–440.
17. Omar M.A., Wilson J.P., Cox T.S. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother, 2001, vol. 35(9), pp. 1096–1107.
18. Charlton M. Obesity, hyperlipidemia, and metabolic syndrome. Liver Transpl, 2009, vol. 15, Suppl 2, pp. s83-s89. doi: 10.1002/lt.21914.
19. Roy A., Kneteman N., Lilly L., Marotta P., Peltekian K., Scudamore C., Tchervenkov J. Tacrolimus as intervention in the treatment of hyperlipidemia after liver transplant. Transplantation, 2006, vol. 82(4), pp. 494–500.
20. Stegall M.D., Everson G.T., Schroter G., Karrer F., Bilir B., Sternberg T., Shrestha R., Wachs M., Kam I. Prednisolone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolaemia without causing graft loss. Hepatology, 1997, vol. 25(1), pp. 173-177. doi: 10.1002/hep.510250132.
21. Lewis J.H., Mortensen M.E., Zweig S., Fusco M.J., Medoff J.R., Belder R. Efficacy and safety of high-dose pravastatin in hypercholesterolemic patients with well-compensated chronic liver disease: Results of a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Hepatology, 2007, vol. 46(5), pp. 1453–1463.
22. Björnsson E.S. Hepatotoxicity of statins and other lipid-lowering agents. Liver Int, 2017, vol. 37(2), pp. 173–178.
23. Neal D.A., Gimson A.E., Gibbs P., Alexander G.J. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl, 2001, vol. 7(6), pp. 533–539.
24. Grigorenko E.A., Mitkovskaya N.P., Roudenok V.V., Rummo O.O. Coronary artery calcification in liver transplant recipients. Vestnik Avitsenny, 2020, vol. 22, no. 2, pp. 246–252.
Поступила 02.09.2021
