Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 28, 2017; 9(15): 697-703
Published online May 28, 2017. doi: 10.4254/wjh.v9.i15.697
Cardiovascular assessment in liver transplant for non-alcoholic steatohepatitis patients: What we do, what we should do
Yolanda Sanchez-Torrijos, Javier Ampuero, Manuel Romero-Gómez
Yolanda Sanchez-Torrijos, Javier Ampuero, Manuel Romero-Gómez, Unidad Intercentros de Aparato Digestivo, Hospitales Universitarios Virgen del Rocio - Virgen Macarena, 41013 Sevilla, Spain
Javier Ampuero, Manuel Romero-Gómez, Instituto de Biomedicina de Sevilla, 41013 Sevilla, Spain
Javier Ampuero, Manuel Romero-Gómez, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
Author contributions: Ampuero J contributed as guarantor of the article; Ampuero J contributed to review design; all authors contributed to drafting the manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Javier Ampuero, MD, PhD, Unidad Intercentros de Aparato Digestivo, Hospitales Universitarios Virgen del Rocio - Virgen Macarena, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain.
Telephone: +34-95-5015761 Fax: +34-95-5015899
Received: January 28, 2017
Peer-review started: February 9, 2017
First decision: March 6, 2017
Revised: April 7, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: May 28, 2017

Non-alcoholic fatty liver disease (NAFLD) is increasing considerably due to the current lifestyle, which means that it is becoming one of the main indications for liver transplantation. On the other hand, there is a strong association between NAFLD and cardiovascular disease. This has been evidenced in many studies revealing a higher presence of carotid plaques or carotid intima-media thickness, leading to cardiovascular events and, ultimately, mortality. According to the liver transplant guidelines, screening for heart disease in transplant candidates should be performed by electrocardiogram and transthoracic echocardiography while a stress echocardiogram should be reserved for those with more than two cardiovascular risk factors or greater than 50 years old. However, there are no specific recommendations in NAFLD patients requiring a liver transplantation, despite its well-known cardiovascular risk association. Many studies have shown that these patients probably require a more exhaustive assessment and a global approach including other specialists such as cardiologists or nutritionists. Also, the incidence of cardiovascular disease is also increased in NAFLD patients in the post-transplantation period in comparison with other etiologies, because of the pre-existent risk factors together with the immunosuppressive therapy. Therefore, an early intervention on the lifestyle and the individualized selection of the immunosuppressive regimen could lead to a modification of the cardiovascular risk factors in NAFLD patients requiring a liver transplantation.

Keywords: Cardiovascular risk, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Pre-transplant assessment, Liver transplantation

Core tip: Non-alcoholic fatty liver disease is a growing condition due to the current lifestyle. It is considered the liver manifestation of the metabolic syndrome, so it is strongly related to cardiovascular disease. Given that is one of the main indications of liver transplantation, it is essential to carry out an adequate assessment of the pre-transplant cardiovascular risk, as well as an individualized management of the patient in the post-transplantation period (due to the pre-existent cardiovascular risk factors and the immunosuppressive therapy).