Cardiometabolic risk profile one year after liver transplantation for nash

Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease worldwide, and the second most common cause of liver transplantation in the UK. Transplantation is physiologically stressful, and is associated with deterioration in cardiometabolic risk factors, as well as disease recurrence after 5 years. Infection is the leading cause of death in the first 5 years post-transplant; subsequently cardiovascular disease and malignancy are the predominant causes of death. Here we retrospectively evaluate a single centre’s experience of assessment and management of cardiometabolic risk factors post transplantation. This was a single-centre study of patients who underwent liver transplantation for NASH cirrhosis between January and December 2021. Data was collected retrospectively for patient’s height, weight, blood pressure, glycated haemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) on initial assessment, admission for transplant, and subsequent visits at 3, 6 and 12 months, post-transplant. QRISK3, the prediction algorithm for cardiovascular risk, was calculated on assessment and 12 months post-operatively (https://qrisk.org). Results shown as mean ± standard deviation, statistical analysis was carried out using GraphPad Prism v9. We identified 27 patients who had a liver transplant for NASH during this time period. We noted a 6.8 kg/m2 increase in mean BMI from assessment to 1 year follow up, 2/26 patients had a new diagnosis of type 2 diabetes. There was a significant increase in blood pressure over the study period: Mean systolic blood pressure 122 ± 15.9 v 150 ± 27.5 mm Hg, p<0.005; Mean diastolic pressure 64 ± 10.3 v 77 ± 8.3 mmHg, p<0.005. Fifty percent of patients had new onset chronic kidney disease stage 3 (CKD3) post-transplant and one died after 7 months due to a myocardial infarction. We noted a significant rise in QRISK3 score 1 year post transplant (Mean = 14% v 27%, p=0.0024); 84.6% of patients at 1 year post transplant, had a QRISK3 score greater than 10, meeting criteria for statin therapy. We would recommend that all patients undergoing liver transplantation for NASH are assessed for risk factors of cardiovascular disease and NASH recurrence at routine follow up appointments, including a QRISK3 assessment. Statins are recommended for primary prophylaxis of major cardiovascular events in those with a QRISK3 greater than 10%. With approximately 85% of patients meeting this criteria, we would advocate for proactive assessment and initiation of therapy in all NASH patients post transplant.