{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:03:42Z","timestamp":1790373822787,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Major adverse cardiovascular events (MACEs) are the leading cause of early (&lt;1\u00a0y) complications after liver transplantation (LT). NASH, the leading indication for waitlisting for LT, is associated with high cardiac risk factor burden. The contemporary prevalence and temporal trends in pretransplant cardiac risk factor burden and post-LT MACE among LT recipients (LTRs) with and without NASH are unknown. The aim of this study was to evaluate (1) the evolution of post-LT cardiac risk factors in LTRs over time and (2) post-LT MACE over time, stratified by NASH status. This is a retrospective cohort of 1775 adult LTRs at a single transplant center (2003\u20132020). MACE was defined as death or hospitalization from myocardial infarction, revascularization, stroke, heart failure during the first post-LT year. Between 2003 and 2020, there was a significant increase in pre-LT NASH (<jats:italic toggle=\"yes\">p<\/jats:italic>\n                           <jats:sub>trend<\/jats:sub> &lt;0.05). There was also a significant increase in pre-LT obesity, atherosclerotic cardiovascular (CV) disease, and older age (\u226565\u00a0y old) (<jats:italic toggle=\"yes\">p<\/jats:italic>\n                           <jats:sub>trend<\/jats:sub>&lt;0.05 for all). There was no significant change in the proportion of LTRs with diabetes, chronic kidney disease, or heart failure. Unexpectedly, there were no changes in the rate of post-LT MACE over the study period (\u22120.1% per year, <jats:italic toggle=\"yes\">p<\/jats:italic>\n                           <jats:sub>trend<\/jats:sub>=0.44). The lack of change in MACE despite an increase in CV risk factor prevalence may reflect advancement in the identification and management of CV risk factors in LTRs. With projected continued increase in cardiac risk burden and the proportion of patients transplanted for NASH, it is critical for LT programs to develop and implement quality improvement efforts to optimize CV care in LTRs.<\/jats:p>","DOI":"10.1097\/lvt.0000000000000013","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T20:00:38Z","timestamp":1675281638000},"page":"581-590","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time"],"prefix":"10.1097","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2577-9087","authenticated-orcid":false,"given":"Claire R.","family":"Harrington","sequence":"first","affiliation":[{"name":"Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4120-905X","authenticated-orcid":false,"given":"Paul","family":"Levy","sequence":"additional","affiliation":[{"name":"Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5180-2754","authenticated-orcid":false,"given":"Elizabeth","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Gao","sequence":"additional","affiliation":[{"name":"Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyanna L.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Padilla","sequence":"additional","affiliation":[{"name":"Division of GI and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1178-4897","authenticated-orcid":false,"given":"Gonzalo","family":"Crespo","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplant Unit, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-2573","authenticated-orcid":false,"given":"Lisa B.","family":"VanWagner","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"R1-20250824","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1002\/lt.23950","article-title":"High early cardiovascular mortality after liver transplantation","volume":"20","author":"VanWagner","year":"2014","journal-title":"Liver transplant"},{"key":"R2-20250824","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1002\/lt.24137","article-title":"Cardiovascular disease after liver transplantation: when, what, and who is at risk","volume":"21","author":"Fussner","year":"2015","journal-title":"Liver Transpl"},{"key":"R3-20250824","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1111\/ajt.13779","article-title":"Factors associated with major adverse cardiovascular events after liver transplantation among a national sample","volume":"16","author":"VanWagner","year":"2016","journal-title":"Am J Transplant"},{"key":"R4-20250824","first-page":"241","article-title":"Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review","volume":"21","author":"Bosco","year":"2021","journal-title":"BMC Med"},{"key":"R5-20250824","doi-asserted-by":"crossref","first-page":"e010541","DOI":"10.1161\/JAHA.118.010541","article-title":"Association of major adverse cardiac events up to 5 years in patients with chest pain without significant coronary artery disease in the Korean population","volume":"8","author":"Choi","year":"2019","journal-title":"JAHA"},{"key":"R6-20250824","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.jhep.2018.12.009","article-title":"Age and liver transplantation","volume":"70","author":"Durand","year":"2019","journal-title":"J Hepatol"},{"key":"R7-20250824","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/hep.30875","article-title":"Redefining cirrhotic cardiomyopathy for the modern era","volume":"71","author":"Izzy","year":"2020","journal-title":"Hepatology"},{"key":"R8-20250824","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidelines from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"R9-20250824","doi-asserted-by":"crossref","first-page":"S1542","DOI":"10.1016\/j.cgh.2021.11.014","article-title":"Outcomes of nonalcoholic steatohepatitis after liver transplantation: an updated meta-analysis and systematic review","volume":"21","author":"Yong","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R10-20250824","doi-asserted-by":"crossref","first-page":"100192","DOI":"10.1016\/j.jhepr.2020.100192","article-title":"NAFLD and liver transplantation: disease burden, current management and future challenges","volume":"2","author":"Burra","year":"2020","journal-title":"JHEP Rep"},{"key":"R11-20250824","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1002\/hep.25855","article-title":"Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events","volume":"56","author":"VanWagner","year":"2012","journal-title":"Hepatology"},{"key":"R12-20250824","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ijcard.2020.11.038","article-title":"Sudden cardiac death following liver transplantation: incidence, trends and risk predictors","volume":"327","author":"Koshy","year":"2021","journal-title":"INt J Cardiol"},{"key":"R13-20250824","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/TP.0000000000003306","article-title":"Prediction of perioperative cardiovascular events in liver transplantation","volume":"105","author":"Koshy","year":"2020","journal-title":"Transplantation"},{"key":"R14-20250824","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1002\/lt.22468","article-title":"Cumulative risk of cardiovascular events after orthotopic liver transplantation","volume":"18","author":"Albeldawi","year":"2012","journal-title":"Liver Transpl"},{"key":"R15-20250824","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ejim.2020.05.041","article-title":"Pre-transplant diabetes predicts atherosclerotic vascular events and cardiovascular mortality in liver transplant recipients: a long-term follow-up study","volume":"79","author":"Gitto","year":"2020","journal-title":"Eur J Intern Med"},{"key":"R16-20250824","first-page":"1407","article-title":"The portrait of an adult liver transplant recipient in the United States from 1987 to 2012","volume":"174","author":"Stepanova","year":"2014","journal-title":"JAMA"},{"key":"R17-20250824","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/lt.25657","article-title":"Nonalcoholic steatohepatitis after liver transplantation","volume":"26","author":"Cotter","year":"2020","journal-title":"Liver Transpl"},{"key":"R18-20250824","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/tri.13358","article-title":"Annual report of the European Liver Transplant Registry (ELTR)\u201450- year evolution of liver transplantation","volume":"31","author":"Adam","year":"2018","journal-title":"Transpl Int"},{"key":"R19-20250824","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jhep.2018.02.012","article-title":"The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition","volume":"69","author":"Crespo","year":"2018","journal-title":"J Hepatol"},{"key":"R20-20250824","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1093\/ehjqcco\/qcaa009","article-title":"Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years","volume":"6","author":"Koshy","year":"2020","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"R21-20250824","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1002\/lt.25863","article-title":"Outcomes of liver transplantation among older recipients with nonalcoholic steatohepatitis in a large multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium","volume":"26","author":"Kwong","year":"2020","journal-title":"Liver Transpl"},{"key":"R22-20250824","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1002\/lt.26443","article-title":"Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplant","volume":"28","author":"Sastre","year":"2022","journal-title":"Liver Transpl"},{"key":"R23-20250824","first-page":"e168","article-title":"Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association","volume":"2","author":"Duell","year":"2022","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"R24-20250824","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1161\/01.cir.0000437741.48606.98","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Goff","year":"2014","journal-title":"Circulation"},{"key":"R25-20250824","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.cgh.2022.02.028","article-title":"Factors impacting survival in those transplanted for NASH cirrhosis: data from the NailNASH Consortium","volume":"21","author":"Rinella","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R26-20250824","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ahj.2022.01.007","article-title":"Female sex-specific and -predominant cardiovascular risk factors and heart failure practice guidelines","volume":"247","author":"Hassan","year":"2022","journal-title":"Am Heart J"},{"key":"R27-20250824","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1161\/CIRCULATIONAHA.117.028595","article-title":"Gender\/sex as a social determinant of cardiovascular risk","volume":"137","author":"O\u2019Neil","year":"2018","journal-title":"Circulation"},{"key":"R28-20250824","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1002\/lt.25613","article-title":"The impact of coronary artery disease and statins on survival after liver transplantation","volume":"25","author":"Patel","year":"2019","journal-title":"Liver Transpl"},{"key":"R29-20250824","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1002\/lt.25067","article-title":"Utilization of aspirin and statin in management of coronary artery disease in patients with cirrhosis undergoing liver transplant evaluation","volume":"24","author":"Patel","year":"2018","journal-title":"Liver Transpl"},{"key":"R30-20250824","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/lt.25973","article-title":"Liver transplant recipient, caregiver, and provider perceptions of cardiovascular disease and related risk factors after transplant","volume":"27","author":"VanWagner","year":"2021","journal-title":"Liver Transpl"},{"key":"R31-20250824","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1002\/hep.29329","article-title":"A point-based prediction model for cardiovascular risk in orthotopic liver transplantation: the CAR-OLT score","volume":"66","author":"VanWagner","year":"2017","journal-title":"Hepatology"},{"key":"R32-20250824","doi-asserted-by":"crossref","first-page":"100582","DOI":"10.1016\/j.aohep.2021.100582","article-title":"Introduction of a standardized protocol for cardiac risk assessment in candidates for liver transplant\u2014a retrospective cohort analysis","volume":"27","author":"McCarthy","year":"2022","journal-title":"Ann Hepatol"},{"key":"R33-20250824","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.cld.2021.01.012","article-title":"Current concepts of cirrhotic cardiomyopathy","volume":"25","author":"Izzy","year":"2021","journal-title":"Clin Liver Dis"},{"key":"R34-20250824","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1002\/lt.26000","article-title":"Cirrhotic cardiomyopathy predicts posttransplant cardiovascular disease: revelations of the new diagnostic criteria","volume":"27","author":"Izzy","year":"2021","journal-title":"Liver Transpl"},{"key":"R35-20250824","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/ajt.14531","article-title":"Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: an evaluation of the evidence and consensus recommendations","volume":"18","author":"VanWagner","year":"2018","journal-title":"Am J Transplant"},{"key":"R36-20250824","first-page":"e766","article-title":"Comanagement with nephrologist care is associated with fewer cardiovascular events among liver transplant recipients with chronic kidney disease","volume":"7","author":"Campbell","year":"2021","journal-title":"Liver Transpl"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/LVT.0000000000000013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T20:01:45Z","timestamp":1756065705000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/LVT.0000000000000013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/lvt.0000000000000013","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1,3]]},"assertion":[{"value":"2022-05-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}