Impact of Abdominal Aortic Calcification Among Liver Transplantation Recipients

Impact of aortic calcification at the origin of celiac artery on post-operative outcomes of major hepatectomy: A significant risk factor for posthepatectomy liver failure

PURPOSE

Aortic calcification is associated with arteriosclerosis and is often seen in patients undergoing hepatectomy. However, its impact on post-operative outcomes after major hepatectomy is still unclear.

METHODS

From July, 2015 to December, 2022, 127 patients who underwent resection of three or more adjacent liver segments (major hepatectomy) were retrospectively reviewed. Aortic calcification at the origin of celiac artery was assessed on pre-operative abdominal CT scan images. pPerioperative factors and postoperative outcomes were compared between patients with and without aortic calcification. Uni-variable and multi-variable analyses were performed to identify risk factors of posthepatectomy liver failure (PHLF).

RESULTS

Aortic calcification at the origin of celiac artery was observed in 62 (48.8%) of 127 patients. Those with aortic calcification were significantly older and had a higher incidence of hypertension, as a comorbidity, compared to those without. Furthermore, incidences of both post-operative liver failure and other complications were significantly higher among patients with aortic calcification, who also had a longer hospital stay. Multivariable logistic analysis identified aortic calcification and longer operation time as independent risk factors of PHLF. Additionally, stenosis of the celiac artery also impacted the development of PHLF.

CONCLUSION

These findings indicate that aortic calcification at the origin of celiac artery is associated with advanced age and may be a risk factor of PHLF following major hepatectomy.

Effect of abdominal aortic calcification on long-term outcomes after the first liver resection in very old patients with hepatocellular carcinoma

Aim

We previously reported that abdominal aortic calcification is associated with poor overall and recurrence-free survival after hepatectomy for hepatocellular carcinoma (HCC). However, the effect of abdominal aortic calcification on cancer-specific prognosis in very old patients with several comorbidities remains unknown. This multicenter study aimed to evaluate the impact of abdominal aortic calcification on the cumulative recurrence rate and recurrence-free survival in patients with HCC aged >80 years.

Methods

We retrospectively analyzed the data of 128 patients (aged ≥80 years) who underwent liver resection for hepatocellular carcinoma at seven hospitals belonging to Hiroshima Surgical Study Group of Clinical Oncology between January 2014 and December 2018. Patients were divided into two groups: high and low abdominal aortic calcification groups. The primary endpoints were cumulative recurrence rate and recurrence-free survival.

Results

Kaplan-Meier survival curve analysis demonstrated that the cumulative recurrence rate in the high abdominal aortic calcification group was significantly higher than that in the low abdominal aortic calcification group, and the high abdominal aortic calcification group had a significantly lower recurrence-free survival rate. In the multivariate analysis, high abdominal aortic calcification (p = 0.03), high des-gamma-carboxyprothrombin score (p = 0.04), and multiple tumors (p < 0.01) were independent predictive factors for recurrent HCC, and high abdominal aortic calcification (p = 0.01) and high des-gamma-carboxyprothrombin (p = 0.01) were independent predictive factors for poor cancer-specific survival.

Conclusions

Our results indicate that the abdominal aortic calcification score is associated with cumulative recurrence rate and recurrence-free survival in very old patients with HCC.

Abdominal aortic calcification among gastroenterological and transplant surgery

This review discusses the increasing global trend towards an aging population, which has resulted in a growing number of surgeries being performed on elderly patients, particularly those living with cancer. The focus was on the implications of abdominal aortic calcification (AAC), an indicator of systemic atherosclerosis, in these patients. This comprehensive review provided evidence detailing the complex processes of atherosclerosis and vascular calcification and various approaches to assess this condition. The prevalence of AAC is related to multiple factors, including cardiovascular disease, inflammation, frailty in various types of gastroenterological surgery. Additionally, notable links were found between AAC, postoperative complications, and patient survival following gastroenterological surgery. This study highlights how AAC could negatively impact the health status of elderly patients and undermine treatment efficacy, stressing the need for more research in this domain to improve patient outcomes.

Association of Abdominal Aortic Calcification With the Postoperative Metabolic Syndrome Components After Liver Transplantation

BACKGROUND

This study aimed to assess the risk factors for components of metabolic syndrome, such as diabetes mellitus, hypertension, and dyslipidemia, more than a year after liver transplantation.

METHODS

This study included 164 patients with liver failure secondary to acute and chronic liver disease or hepatocellular carcinoma who underwent liver transplantation between 2000 and 2019. Univariate and multivariate analyses were performed to identify the risk factors associated with metabolic syndrome components after liver transplantation.

RESULTS

The median follow-up period was 10.5 years. Of the 164 patients who underwent liver transplantation, 144 (87.8%) developed components of metabolic syndrome after liver transplantation. The most common cause of liver failure was hepatitis C virus infection (34.1%). The incidence of hepatocellular carcinoma was 36.0%. In univariate analysis, preoperative diabetes mellitus was a significantly more common component of metabolic syndrome than the others. In multivariate analysis, preoperative abdominal aortic calcification was a risk factor for the new onset of all components of metabolic syndrome after liver transplantation, despite the varying degree of calcification at risk of development (odds ratio for diabetes mellitus = 3.487, P = .0069; odds ratio for hypertension = 2.914, P = .0471; odds ratio for dyslipidemia = 3.553, P = .0030).

CONCLUSIONS

Preoperative abdominal aortic calcification was significantly associated with the development of each metabolic syndrome component after liver transplantation.

Atherosclerosis Deteriorates Liver Ischemia/Reperfusion Injury Via Interferon Regulatory Factor-1 Overexpression in a Murine Model

BACKGROUND

Abdominal aortic calcification (AAC) is associated with cardiovascular-related mortality, along with an elevated risk of coronary, cerebrovascular, and cardiovascular events. Notably, AAC is strongly associated with poor overall and recurrence free survival posthepatectomy for hepatocellular carcinoma. Despite the acknowledged significance of atherosclerosis in systemic inflammation, its response to ischemia/reperfusion injury (IRI) remains poorly elucidated. In this study, we aimed to clarify the impact of atherosclerosis on the liver immune system using a warm IRI mouse model.

METHODS

Injury was induced in an atherosclerotic mouse model (ApoE-/-) or C57BL/6J wild-type (WT) mice through 70% clamping for 1 hour and analyzed after 6 hours of reperfusion.

RESULTS

Elevated serum levels of aspartate and alanine aminotransferase, along with histological assessment, indicated considerable damage in the livers of ApoE-/- mice than that in WT mice. This indicates a substantial contribution of atherosclerosis to IRI. Furthermore, T and natural killer (NK) cells in ApoE-/- mouse livers displayed a more inflammatory phenotype than those in WT mouse livers. Reverse transcription-polymerase chain reaction analysis revealed a significant upregulation of interleukin (IL)-15 and its transcriptional regulator, interferon regulatory factor-1 (IRF-1) in ApoE-/- mouse livers compared with that in WT mouse livers.

CONCLUSIONS

These findings suggest that in an atherosclerotic mouse model, atherosclerosis can mirror intrahepatic immunity, particularly activating liver NK and T cells through IL-15 production, thereby exacerbating hepatic damage. The upregulation of IL-15 expression is associated with IRF-1 overexpression.

Blood urea nitrogen concentration is associated with severe abdominal aortic calcification in adults: a cross-sectional investigation

The purpose of this research is to examine the correlation between blood urea nitrogen (BUN) and severe abdominal aortic calcification (AAC) among American adults aged 40 years and older. A total of 2757 participants in the NHANES from 2013 to 2014 were included in the final analysis. BUN was measured by means of the enzymatic conductivity rate method. AAC scores were quantified by the Kauppila scoring system, and severe AAC was defined as an AAC score ≥ 6. Multivariable logistic regression and restricted cubic splines were used in the analyses. In the multivariable logistic regression model, the highest BUN level (log 2-transformed) was associated with an increased risk of severe AAC [odds ratio (OR) = 1.77, 95% CI 1.17, 2.71]. The restricted cubic spline plot displayed a reverse L-shaped association between BUN (log2-transformed) and severe AAC (p for nonlinearity < 0.001). In addition,the interactions of BUN were not discover. In general, there is a positive correlation between BUN and the risk of severe AAC.

Impact of Abdominal Aortic Calcification on Chronic Kidney Disease After Liver Transplantation: A Retrospective Study

BACKGROUND

With improved graft and patient survival after liver transplantation (LT), the onset of late complications, such as renal dysfunction, has become a problem. In this study, we aimed to investigate abdominal aortic calcification (AAC), a potential indicator of systemic atherosclerosis, and evaluate the relationship between preoperative AAC and postoperative chronic kidney disease (CKD), as the latter might be a long-term complication after LT.

METHODS

Among the 184 LTs performed at our center between 2008 and 2021, 110 LTs with normal renal function (estimated glomerular filtration rate [eGFR] 60 mL/min per 1.73 m2) before surgery were included. These were divided into high- (≥100 mm3) and low-AAC groups (<100 mm3) consisting of 51 and 59 patients, respectively. The AAC volume was automatically calculated for calcifications located in the abdominal aorta using the Agatston method.

RESULTS

The high-AAC group was older, consisted of more men, and had lower preoperative creatinine and eGFR levels. No significant difference in the onset of postoperative CKD was found between the 2 groups. However, the cumulative incidence of postoperative CKD was significantly higher in the high-AAC group compared with the low-AAC group. Multivariate analysis of postoperative CKD using the Cox proportional hazards model showed significant differences in preoperative AAC ≥100 mm3, recipient age ≥50 years, and preoperative eGFR <75 mL/min per 1.73 m2.

CONCLUSIONS

The development of postoperative CKD should be monitored in liver transplant recipients despite normal preoperative renal function. Our study suggests that preoperative AAC may influence postoperative renal dysfunction.

Assessment of Vascular and Valvular Calcification Improves Screening for Coronary Artery Disease Before Liver Transplantation

Coronary artery disease (CAD) is common in patients with cirrhosis who underwent orthotopic liver transplantation (OLT) evaluation and stress echocardiogram (echo) has a low sensitivity in these patients. This study aimed to assess the impact of vascular and valvular calcification on the ability to identify CAD before OLT. We performed a case-control study of 88 patients with and 97 without obstructive CAD who underwent OLT evaluation. All patients had a preoperative stress echo, abdominal computed tomography, and cardiac catheterization. A series of nested logistic regression models of CAD were fit by adding independent variables of vascular (including coronary) calcification, aortic and mitral valve calcification, age, gender, and history of diabetes mellitus requiring insulin to a baseline model of abnormal stress echo. Compared with stress echo alone, identification of the presence or absence of vascular and valvular calcification on routine preoperative computed tomography and echo improved the diagnostic performance for the detection of CAD based on coronary angiogram when combined with stress echo in patients with cirrhosis who underwent OLT evaluation (area under the curve 0.58 vs 0.73, p <0.001), which is even further improved when age, gender, and history of diabetes mellitus requiring insulin are considered (area under the curve 0.58 vs 0.80, p <0.001). Achieving target heart rate (p = 0.92) or rate-pressure product >25,000 (p = 0.63) did not improve the ability of stress echo to identify CAD. In conclusion, the use of abdominal vascular, coronary artery, and valvular calcification, along with stress echo, improves the ability to identify and rule out obstructive CAD before OLT compared with stress echo alone.

Abdominal aortic calcification volume (AACV) is a predictive factor for postoperative complications associated with biliary tract cancer

PURPOSE

Curative surgical treatment of biliary tract cancer is highly invasive and involves postoperative complications. Abdominal aortic calcification is a parameter that is reportedly linked to systemic arteriosclerosis. We measured the abdominal aortic calcification volume (AACV), assessed the correlation between AACV and postoperative complications, and evaluated the clinical utility of AACV.

METHODS

We retrospectively evaluated 97 patients (ampullary carcinoma, n = 21; distal bile duct cancer, n = 43; hilar bile duct cancer, n = 33). We assessed the calcification volume of the abdominal aorta from the renal artery ramification to the common iliac artery bifurcation. The correlation between AACV, clinical factors, and postoperative complications was evaluated.

RESULTS

The average AACV was 5.02 cm³, and the median AACV was 3.74 (range 0-27.4) cm³. The AACV was significantly related to age (P = 0.009), Brinkman index (P = 0.007), and history of cardiovascular disease (P = 0.015). The AACV was strongly correlated with postoperative complications (P < 0.001) and Clavien-Dindo grade > III postoperative complications (P < 0.001). The AACV was also correlated with pancreatic fistula in pancreatectomy cases (P < 0.001). A multivariate analysis revealed that the AACV was an independent predictor of postoperative complications.

CONCLUSION

The AACV was significantly associated with postoperative complications. The AACV could be used for the preoperative assessment of surgical risk.

Effect of abdominal aortic calcification on the prognosis and recurrence of colorectal cancer stages II-III: A retrospective cohort study

PURPOSE

Abdominal aortic calcification (AAC) is a well-known risk marker for cardiovascular disease. However, its clinical effect on patients who underwent radical surgery for colorectal cancer (CRC) stages II-III is unclear. This study aimed to analyze the associations between AAC and prognosis of patients with stage II-III CRC.

METHODS

To evaluate the effect of AAC on clinical outcomes, prognosis, and metastatic patterns of CRC, we analyzed 362 patients who underwent radical surgery for stage II-III CRC between 2010 and 2018.

RESULTS

The high AAC group had significantly worse overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) after propensity score matching to adjust for differences in baseline characteristics of patients and tumors. In the multivariate Cox regression analyses, a high AAC was an independent risk factor for poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.23-4.59; p = 0.01), poor CSS (HR, 5.22; 95% CI, 1.74-15.6; p < 0.01), and poor RFS (HR, 1.83; 95% CI, 1.19-2.83; p < 0.01). A high AAC was not associated with a risk of lung metastasis or local or peritoneal recurrence, but a risk for liver metastasis of CRC.

CONCLUSION

A high AAC showed a strong relationship with poor OS, CSS, and RFS after curative resection for stage II-III CRC. A high AAC was also associated with a risk for liver metastasis, which may worsen the prognosis in stage II-III CRC. AAC could be a new clinical tool for predicting the prognosis for patients in stage II-III CRC.

Calcification of the visceral aorta and celiac trunk is associated with renal and allograft outcomes after deceased donor liver transplantation

PURPOSE

Atherosclerosis affects clinical outcomes in the setting of major surgery. Here we aimed to investigate the prognostic role of visceral aortic (VAC), extended visceral aortic (VAC+), and celiac artery calcification (CAC) in the assessment of short- and long-term outcomes following deceased donor orthotopic liver transplantation (OLT) in a western European cohort.

METHODS

We retrospectively analyzed the data of 281 consecutive recipients who underwent OLT at a German university medical center (05/2010-03/2020). The parameters VAC, VAC+, or CAC were evaluated by preoperative computed tomography-based calcium quantification according to the Agatston score.

RESULTS

Significant VAC or CAC were associated with impaired postoperative renal function (p = 0.0016; p = 0.0211). Patients with VAC suffered more frequently from early allograft dysfunction (EAD) (38 vs 26%, p = 0.031), while CAC was associated with higher estimated procedural costs (p = 0.049). In the multivariate logistic regression analysis, VAC was identified as an independent predictor of EAD (2.387 OR, 1.290-4.418 CI, p = 0.006). Concerning long-term graft and patient survival, no significant difference was found, even though patients with calcification showed a tendency towards lower 5-year survival compared to those without (VAC: 65 vs 73%, p = 0.217; CAC: 52 vs 72%, p = 0.105). VAC+ failed to provide an additional prognostic value compared to VAC.

CONCLUSION

This is the first clinical report to show the prognostic role of VAC/CAC in the setting of deceased donor OLT with a particular value in the perioperative phase. Further studies are warranted to validate these findings. CT computed tomography, OLT orthotopic liver transplantation.

Serum Chloride Level Is Associated With Abdominal Aortic Calcification

Background

Abdominal aortic calcification is a potentially important independent risk factor for cardiovascular health. The aim of this study was to determine the relationship between serum chloride level and abdominal artery calcification.

Methods

We obtained the data of 3,018 individuals from the National Health and Nutrition Examination Survey database and analyzed the relationship between serum chloride and abdominal artery calcification. We performed stratified and single factor analysis, multiple equation regression analysis, smooth curve fitting, and threshold effect and saturation effect analysis. R and EmpowerStats were used for data analysis.

Results

Serum chloride is independently related to the AAC total 24 score (AAC-24). The smooth curves fitted were all inverted-U shaped. Below a cutoff value of 92 mmol/L, increase in serum chloride level was associated with increase in AAC-24; however, above that cutoff, increase in serum chloride level was associated with decrease in AAC-24.

Conclusions

At serum levels below 92 mmol/L, chloride is a risk factor for abdominal aortic calcification but levels above 92 mmol/L appear to protect against abdominal aortic calcification.

Impact of abdominal aortic calcification on clinical outcomes following initial hepatectomy for hepatocellular carcinoma: A retrospective cohort study

AIM

The clinical impact of abdominal aortic calcification (AAC) in patients who undergo hepatectomy for hepatocellular carcinoma (HCC) is unknown.

METHODS

To evaluate the impact of AAC on clinical outcomes, we analyzed 203 patients who underwent hepatectomy for HCC between 2010 and 2013.

RESULTS

Kaplan-Meier survival curve analysis showed significantly worse overall survival (OS) in the high AAC group than in the low AAC group. The recurrence-free survival (RFS) was also significantly worse in the high AAC group. In the multivariate analysis, high AAC (hazard ratio [HR], 2.51; 95% confidence interval [CI], 1.24-5.09; P = .01) was an independent risk factor for poor OS after hepatectomy for HCC. High AAC was also an independent risk factor for poor RFS (HR, 1.69; 95% CI, 1.04-2.76; P = .04).

CONCLUSIONS

Abdominal aortic calcification had a strong relationship with poor OS and RFS after hepatectomy for HCC. We suggest that AAC had a relationship with smoking and diabetes; therefore, AAC could reflect a surrogate for older age, worse health status, and inflammatory score.

Impact of Image Reconstruction Parameters on Abdominal Aortic Calcification Measurement Using Abdominal Computed Tomography

BACKGROUND AND AIMS

Abdominal aortic calcification (AAC) is correlated with cardiovascular outcomes independent of traditional risk factors. Quantification of AAC on computed tomography (CT) has not been standardized. Reconstruction parameters have been shown to impact coronary calcium scores. The aim of our study was to assess the impact of abdominal CT reconstruction parameters, slice thickness (ST), and display field of view (DFOV) on AAC quantitative scoring on abdominal CT examinations.

METHODS

We retrospectively measured AAC on noncontrast CT of 46 patients (mean age, 64.1 years; 35 males) using 5 different reconstruction protocols with a range of ST and DFOV: protocol A, 2.5 mm ST, 35 cm DFOV; protocol B, 2.5 mm ST, 50 cm DFOV; protocol C, 2.5 mm ST, 25 cm DFOV; protocol D, 5 mm ST, 35 cm DFOV; and protocol E: 0.625 mm ST, 35 cm DFOV. The AAC scores from each protocol were compared using concordance correlation coefficient and Bland-Altman agreement analyses.

RESULTS

The AAC mean (SD) scores for each protocol were as follows: A, 2022 (2418); B, 2022 (2412); C, 1939 (2310); D, 2220 (2695); and E, 1862 (2234). The AAC mean score differences between protocols and reference protocol A were -0.47, 82.01, -198.94, and 160 for protocols B, C, D, and E, respectively, with differences between protocols C to E statistically significantly different (P < 0.05). The different protocols showed overall excellent correlation (concordance correlation coefficient, >0.9) between AAC scores.

CONCLUSIONS

Slice thickness and DFOV can impact AAC score measurement. A description of reconstruction parameters is important to allow comparisons across different cohorts.

Impact on biliary complications of donor abdominal aortic calcification among living donor liver transplantation: a retrospective study

Abdominal aortic calcification (AAC) was reported as a poor prognostic factor among liver transplantation. However, donor AAC is not enough discussed. We analyzed the impact of the donor AAC level on graft function on outcomes following living donor liver transplantation (LDLT). A total of 133 consecutive patients who had undergone LDLT were divided into two groups (non-AAC group and AAC group) according to their donor AAC level by plain computed tomography. The rate of postoperative biliary complications (BC) was significantly higher in AAC group (N = 17) than in non-AAC group (N = 116; HR, 2.77; 95% CI, 1.32-5.83; P = 0.0008). The Cox proportional hazards regression model revealed that donor AAC (HR, 4.15; 95% CI, 1.93-8.97; P = 0.0003) and right lobe graft (HR, 2.81; 95% CI, 1.41-5.61; P = 0.003) increased the risk of BC. Conversely, splenectomy (HR, 0.39; 95% CI, 0.16-0.92; P = 0.03) decreased the risk of BC after LDLT independently. The long-term survival was also significantly worse in AAC group than in non-AAC group (HR, 2.25; 95% CI, 1.04-4.89; P = 0.04). Donor AAC was an independent prognostic factor for BC among patients undergoing LDLT. Although further investigations are needed to verify our results, the levels of donor AAC could be a useful tool to identify the risks of BC and predict better outcomes following LDLT.