1
|
Sandhu AT, Kohsaka S, Lin S, Woo CY, Goldstein MK, Heidenreich PA. Renin-angiotensin-aldosterone system inhibitors and SARS-CoV-2 infection: an analysis from the veteran's affairs healthcare system. Am Heart J 2021; 240:46-57. [PMID: 34126079 PMCID: PMC8196226 DOI: 10.1016/j.ahj.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are known to impact the functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The association between chronic therapy with these medications and infection risk remains unclear. OBJECTIVES The objective was to determine the association between prior ACEI or ARB therapy and SARS-CoV-2 infection among patients with hypertension in the U.S. Veteran's Affairs health system. METHODS We compared the odds of SARS-CoV-2 infection among three groups: patients treated with ACEI, treated with ARB, or treated with alternate first-line anti-hypertensives without ACEI/ARB. We excluded patients with alternate indications for ACEI or ARB therapy. We performed an augmented inverse propensity weighted analysis with adjustment for demographics, region, comorbidities, vitals, and laboratory values. RESULTS Among 1,724,723 patients with treated hypertension, 659,180 were treated with ACEI, 310,651 with ARB, and 754,892 with neither. Before weighting, patients treated with ACEI or ARB were more likely to be diabetic and use more anti-hypertensives. There were 13,278 SARS-CoV-2 infections (0.8%) between February 12, 2020 and August 19, 2020. Patients treated with ACEI had lower odds of SARS-CoV-2 infection (odds ratio [OR] 0.93; 95% CI: 0.89-0.97) while those treated with ARB had similar odds (OR 1.02; 95% CI: 0.96-1.07) compared with patients treated with alternate first-line anti-hypertensives without ACEI/ARB. In falsification analyses, patients on ACEI did not have a difference in their odds of unrelated outcomes. CONCLUSIONS Our results suggest the safety of continuing ACEI and ARB therapy. The association between ACEI therapy and lower odds of SARS-CoV-2 infection requires further investigation.
Collapse
Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA.
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shoutzu Lin
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA
| | | | - Mary K Goldstein
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA; Center for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford, CA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA; Medical Service, VA Palo Alto Health Care System, Palo Alto, CA
| |
Collapse
|
2
|
Huang C, Soleimani J, Herasevich S, Pinevich Y, Pennington KM, Dong Y, Pickering BW, Barwise AK. Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review. Mayo Clin Proc 2021; 96:183-202. [PMID: 33413817 PMCID: PMC7586927 DOI: 10.1016/j.mayocp.2020.10.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between January 1, 2020, and May 15, 2020, we identified high-quality clinical studies describing critically ill patients with a sample size of greater than 20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full text (218 articles), and abstracted data (92 studies). The 92 studies included 61 from Asia, 16 from Europe, 10 from North and South America, and 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of comorbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (eg, pulmonary embolism) and epidemiological risk factors (eg, obesity), less chest computed tomography performed, and increased use of invasive mechanical ventilation (70% to 100% vs 15% to 47% of intensive care unit patients) in Europe and the United States compared with Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, interleukin 6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.
Collapse
Key Words
- acei, angiotensin-converting enzyme inhibitor
- apache, acute physiology and chronic health evaluation
- arb, angiotensin receptor blocker
- ards, acute respiratory distress syndrome
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- eua, emergency use authorization
- hfnc, high-flow nasal cannula oxygen therapy
- icu, intensive care unit
- if, impact factor
- il, interleukin
- imv, invasive mechanical ventilation
- los, length of stay
- nimv, noninvasive mechanical ventilation
- pe, pulmonary embolism
- rct, randomized clinical trial
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sofa, sequential organ failure assessment
Collapse
Affiliation(s)
- Chanyan Huang
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
3
|
Alkhouli M, Nanjundappa A, Annie F, Bates MC, Bhatt DL. Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry. Mayo Clin Proc 2020; 95:1613-1620. [PMID: 32753136 PMCID: PMC7256502 DOI: 10.1016/j.mayocp.2020.05.014] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To confirm whether a relationship exists between male sex and coronavirus disease 2019 (COVID-19) mortality and whether this relationship is age dependent. PATIENTS AND METHODS We queried the COVID-19 Research Network, a multinational database using the TriNetX network, to identify patients with confirmed COVID-19 infection. The main end point of the study was all-cause mortality. RESULTS A total of 14,712 patients were included, of whom 6387 (43%) were men. Men were older (mean age, 55.0±17.7 years vs 51.1±17.9 years; P<.001) and had a higher prevalence of hypertension, diabetes, coronary disease, obstructive pulmonary disease, nicotine dependence, and heart failure but a lower prevalence of obesity. Before propensity score matching (PSM), all-cause mortality rate was 8.8% in men and 4.3% in women (odds ratio, 2.15; 95% CI, 1.87 to 2.46; P<.001) at a median follow-up duration of 34 and 32 days, respectively. In the Kaplan-Meier survival analysis, the cumulative probability of survival was significantly lower in men than in women (73% vs 86%; log-rank, P<.001). After PSM, all-cause mortality remained significantly higher in men than in women (8.13% vs 4.60%; odds ratio, 1.81; 95% CI, 1.55 to 2.11; P<.001). In the Kaplan-Meier survival analysis, the cumulative probability of survival remained significantly lower in men than in women (74% vs 86%; log-rank, P<.001). The cumulative probability of survival remained significantly lower in propensity score-matched men than in women after excluding patients younger than 50 years and those who were taking angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications on admission. CONCLUSION Among patients with COVID-19 infection, men had a significantly higher mortality than did women, and this difference was not completely explained by the higher prevalence of comorbidities in men.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Aravinda Nanjundappa
- Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV; Department of Medicine, Division of Cardiology, West Virginia University, Charleston Division, Charleston, WV
| | - Frank Annie
- Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV
| | - Mark C Bates
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Division of Cardiology, Charleston Area Medical Center Institute (CAMC) for Academic Medicine and CAMC Health, Education and Research Institute, Charleston, WV
| | - Deepak L Bhatt
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| |
Collapse
|
4
|
Bos JM, Hebl VB, Oberg AL, Sun Z, Herman DS, Teekakirikul P, Seidman JG, Seidman CE, Dos Remedios CG, Maleszewski JJ, Schaff HV, Dearani JA, Noseworthy PA, Friedman PA, Ommen SR, Brozovich FV, Ackerman MJ. Marked Up-Regulation of ACE2 in Hearts of Patients With Obstructive Hypertrophic Cardiomyopathy: Implications for SARS-CoV-2-Mediated COVID-19. Mayo Clin Proc 2020; 95:1354-1368. [PMID: 32448590 PMCID: PMC7186205 DOI: 10.1016/j.mayocp.2020.04.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore the transcriptomic differences between patients with hypertrophic cardiomyopathy (HCM) and controls. PATIENTS AND METHODS RNA was extracted from cardiac tissue flash frozen at therapeutic surgical septal myectomy for 106 patients with HCM and 39 healthy donor hearts. Expression profiling of 37,846 genes was performed using the Illumina Human HT-12v3 Expression BeadChip. All patients with HCM were genotyped for pathogenic variants causing HCM. Technical validation was performed using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. This study was started on January 1, 1999, and final analysis was completed on April 20, 2020. RESULTS Overall, 22% of the transcriptome (8443 of 37,846 genes) was expressed differentially between HCM and control tissues. Analysis by genotype revealed that gene expression changes were similar among genotypic subgroups of HCM, with only 4% (1502 of 37,846) to 6% (2336 of 37,846) of the transcriptome exhibiting differential expression between genotypic subgroups. The qRT-PCR confirmed differential expression in 92% (11 of 12 genes) of tested transcripts. Notably, in the context of coronavirus disease 2019 (COVID-19), the transcript for angiotensin I converting enzyme 2 (ACE2), a negative regulator of the angiotensin system, was the single most up-regulated gene in HCM (fold-change, 3.53; q-value =1.30×10-23), which was confirmed by qRT-PCR in triplicate (fold change, 3.78; P=5.22×10-4), and Western blot confirmed greater than 5-fold overexpression of ACE2 protein (fold change, 5.34; P=1.66×10-6). CONCLUSION More than 20% of the transcriptome is expressed differentially between HCM and control tissues. Importantly, ACE2 was the most up-regulated gene in HCM, indicating perhaps the heart's compensatory effort to mount an antihypertrophic, antifibrotic response. However, given that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses ACE2 for viral entry, this 5-fold increase in ACE2 protein may confer increased risk for COVID-19 manifestations and outcomes in patients with increased ACE2 transcript expression and protein levels in the heart.
Collapse
Key Words
- δct, transcript of interest minus gapdh control
- ace2, angiotensin i converting enzyme 2
- acei, angiotensin-converting enzyme inhibitor
- arb, angiotensin receptor blocker
- at1r, angiotensin type 1 receptor
- bp, blood pressure
- cdna, complementary dna
- chf, congestive heart failure
- covid-19, coronavirus disease 2019
- ecg, electrocardiogram
- gtp, guanosine triphosphate
- hcm, hypertrophic cardiomyopathy
- hrsace2, human recombinant soluble angiotensin i converting enzyme 2
- htn, hypertension
- icu, intensive care unit
- iqr, interquartile range
- lv, left ventricular
- mig, maximum instantaneous gradient
- mrna, messenger rna
- mybpc3, myosin binding protein c
- myh7, beta myosin heavy chain
- na, not available
- ns, not significant
- nyha, new york heart association
- qrt-pcr, quantitative real-time polymerase chain reaction
- raas, renin-angiotensin-aldosterone system
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- scd, sudden cardiac death
- utr, untranslated region
Collapse
Affiliation(s)
- J Martijn Bos
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Virginia B Hebl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ann L Oberg
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Zhifu Sun
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA; Howard Hughes Medical Institute, Chevy Chase, MD
| | | | | | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Michael J Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN.
| |
Collapse
|
5
|
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc 2020; 95:1445-1453. [PMID: 32622449 PMCID: PMC7236707 DOI: 10.1016/j.mayocp.2020.05.006] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/09/2023]
Abstract
Obesity has reached epidemic proportions in the United States and in much of the westernized world, contributing to considerable morbidity. Several of these obesity-related morbidities are associated with greater risk for death with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 penetrates human cells through direct binding with angiotensin-converting enzyme 2 receptors on the cell surface. Angiotensin-converting enzyme 2 expression in adipose tissue is higher than that in lung tissue, which means that adipose tissue may be vulnerable to COVID-19 infection. Obese patients also have worse outcomes with COVID-19 infection, including respiratory failure, need for mechanical ventilation, and higher mortality. Clinicians need to be more aggressive when treating obese, especially severely obese, patients with COVID-19 infection.
Collapse
Key Words
- ace, angiotensin-converting enzyme
- acei, angiotensin-converting enzyme inhibitor
- af, atrial fibrillation
- ang ii, angiotensin ii
- arb, angiotensin receptor blocker
- bmi, body mass index
- chd, coronary heart disease
- ckd, chronic kidney disease
- covid-19, coronavirus disease 2019
- cvd, cardiovascular disease
- et, exercise training
- hf, heart failure
- htn, hypertension or hypertensive
- mets, metabolic syndrome
- or, odds ratio
- pa, physical activity
- raas, renin-angiotensin-aldosterone system
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sns, sympathetic nervous
- t2dm, type 2 diabetes mellitus
- vte, venous thromboembolism
Collapse
Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain; Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Sanchis-Gomar F, Lavie CJ, Perez-Quilis C, Henry BM, Lippi G. Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019. Mayo Clin Proc 2020; 95:1222-1230. [PMID: 32376099 PMCID: PMC7129862 DOI: 10.1016/j.mayocp.2020.03.026] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease.
Collapse
Key Words
- ace, angiotensin-converting enzyme
- acei, angiotensin-converting enzyme inhibitor
- ali, acute lung injury
- ang, angiotensin
- arb, angiotensin receptor blocker
- ards, acute respiratory distress syndrome
- at1r, angiotensin ii type 1 receptor
- bp, blood pressure
- ckd, chronic kidney disease
- covid-19, coronavirus disease 2019
- cv, cardiovascular
- cvd, cardiovascular disease
- dm, diabetes mellitus
- hf, heart failure
- htn, hypertension
- masr, mas receptor
- raas, renin-angiotensin-aldosterone system
- s, spike
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- tmprss2, type ii transmembrane serine proteases
Collapse
Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Spain; Division of Cardiovascular Medicine, Stanford University School of Medicine, CA.
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Carme Perez-Quilis
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Spain
| | - Brandon M Henry
- Cardiac Intensive Care Unit, Heart Institute, Cincinnati Children's Hospital Medical Center, OH
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Italy
| |
Collapse
|
7
|
Singh S, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87:779-90. [PMID: 22763347 PMCID: PMC3498400 DOI: 10.1016/j.mayocp.2012.02.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/07/2012] [Accepted: 02/16/2012] [Indexed: 12/18/2022]
Abstract
Recognition, management, and prevention of medical complications and comorbidities after liver transplant is the key to improved long-term outcomes. Beyond allograft-related complications, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies are leading causes of morbidity and mortality in this patient population. Primary care physicians have an important role in improving outcomes of liver transplant recipients and are increasingly relied on for managing these complex patients. This review serves to assist the primary care physician in the long-term management issues of liver transplant recipients.
Collapse
Key Words
- acei, angiotensin converting enzyme inhibitor
- arb, angiotensin receptor blocker
- ckd, chronic kidney disease
- cni, calcineurin inhibitor
- ibd, inflammatory bowel disease
- lt, liver transplant
- mmf, mycophenolate mofetil
- mtor, mammalian target of rapamycin
- nash, nonalcoholic steatohepatitis-related cirrhosis
- olt, orthotopic liver transplant
- psc, primary sclerosing cholangitis
Collapse
Affiliation(s)
| | - Kymberly D. Watt
- Correspondence: Address to Kymberly D. Watt, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| |
Collapse
|