BACKGROUND: Orthotopic liver transplantation (OLT) has greatly improved short-term survival for end-stage liver disease. However, cardiovascular events (CVE) still pose a significant threat to long-term post-transplant health. Aim of this study is to assess the occurrence of long-term cardiovascular events and whether it relates to new-onset diabetes after liver transplantation (NODALT). METHODS: We conducted a multicentric retrospective analysis of adult OLT recipients with regular follow-up visits spanning from January 1995 to December 2020. Data collection included anamnestic, clinical, anthropometric, and laboratory data from two centers. NODALT was diagnosed following ADA guidelines. The primary outcome was incident CVE (a composite of fatal and non-fatal stroke and myocardial infarction). CVE occurrence was analyzed in relation to NODALT diagnosis, along with clinical characteristics associated with its development. RESULTS: Ninety-three eligible Caucasian patients, with a median age of 57.0 years (IQR: 49.0-62.0, 69.9% male), were enrolled. Over the median follow-up period of 100.5 months, 29 patients (31.2%) developed NODALT, and 14 patients (15.1%) developed any CVE, with 9 being in the NODALT group. A significant association between NODALT and cardiovascular complications was confirmed by both generalized estimating equation (OR 5.31; 95% CI 1.59-17.72, p = 0.006) and Kaplan-Meier analysis (log-rank = 0.046). Metabolic syndrome and impaired fasting glucose were identified as baseline risk factors for the incident NODALT (OR 5.75; 95% CI 1.44-22.92, p = 0.013 and OR 7.29; 95% CI 1.46-36.41, p = 0.015, respectively). CONCLUSIONS: Post-OLT cardiovascular events are less frequent than previously reported but are notably linked to NODALT, highlighting the interplay between metabolic syndrome and impaired fasting glucose.

Department of Advanced Medical and Surgical Sciences University of Campania Luigi Vanvitelli Naples 1 80138 Italy

Department of Biology College of Science and Technology Sbarro Institute for Cancer Research and Molecular Medicine Temple University Philadelphia PA USA

Department of Experimental Medicine University of Campania Luigi Vanvitelli Naples 1 80138 Italy

Department of Internal Medicine 3rd Faculty of Medicine Charles University and Královské Vinohrady University Hospital Prague Czech Republic

Department of Medicine and Health Sciences Vincenzo Tiberio Università degli Studi del Molise Campobasso 86100 Italy

Department of Precision Medicine University of Campania Luigi Vanvitelli Naples 1 80138 Italy

Division of Cardiology Department of Medical Translational Sciences University of Campania Luigi Vanvitelli Naples Italy

Team MetaDiab Institute of Metabolic and Cardiovascular Diseases INSERM Paul Sabatier University UMR1297 Toulouse France

Unit of Hepatology and Interventional Ultrasonography Department of Internal Medicine OORR Area Stabiese Gragnano 80054 Italy

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