Cardiology - Case Reports Open access

Transplantation of heterozygous familial hypercholesterolemia living donor liver resulting in early myocardial infarction: a possible dangerous link

Authors

Published
16 January 2024
Section
Cardiology - Case Reports
DOI
10.4081/monaldi.2024.2907

Abstract

Living donor liver transplantation (LDLT) is a lifesaving procedure that is often curative for several liver diseases. Familial hypercholesterolemia (FH) is a metabolic disease that results from an autosomal dominant mutation in the low-density lipoprotein receptor; yet, young patients with FH can live years without detection. Herein, we report a case of a patient who developed early myocardial infarction (MI) after having a transplant from a donor with undetected heterozygous FH. The patient was a 67-year-old female with non-alcoholic steatohepatitis-related liver cirrhosis, free from coronary artery disease, who underwent LDLT from her daughter, a 45-year-old female with no past medical history. One year post-transplantation, she presented with an acute MI with a large atherosclerotic burden. Genetic analysis confirmed heterozygous FH in the donor but not in the recipient. This case emphasizes the importance of incorporating a thorough clinical history and lipid profile into pre-transplant testing for both the recipient and donor, as well as aggressive lipid-lowering therapy post-transplantation to avoid cardiovascular complications.

Keywords

Ethics Approval

The study was approved by the office of research affairs and the Ethical Committee of our Institution (approval number: RAC 2191111).

References

  1. Goldaracena N, Barbas AS. Living donor liver transplantation. Curr Opin Organ Transplant 2019;24:131-7. DOI: https://doi.org/10.1097/MOT.0000000000000610
  2. Trotter JF. Selection of donors for living donor liver transplantation. Liver Transpl 2003;9:S2-7. DOI: https://doi.org/10.1053/jlts.2003.50221
  3. Neuberger J. An update on liver transplantation: a critical review. J Autoimmun 2016;66:51-9. DOI: https://doi.org/10.1016/j.jaut.2015.08.021
  4. Nikkilä K, Åberg F, Isoniemi H. Transmission of LDLR mutation from donor through liver transplantation resulting in hypercholesterolemia in the recipient. Am J Transplant 2014;14:2898-902. DOI: https://doi.org/10.1111/ajt.12961
  5. Kholaif N, Mohamed TI, Alharbi IS, et al. Management and clinical outcomes of patients with homozygous familial hypercholesteremia in Saudi Arabia. Monaldi Arch Chest Dis 2023;93. doi:10.4081/monaldi.2023.2503 DOI: https://doi.org/10.4081/monaldi.2023.2503
  6. Al-Rasadi K, Al-Waili K, Al-Sabti HA, et al. Criteria for diagnosis of familial hypercholesterolemia: a comprehensive analysis of the different guidelines, appraising their suitability in the Omani Arab population. Oman Med J 2014;29:85-91. DOI: https://doi.org/10.5001/omj.2014.22
  7. Setia N, Saxena R, Arora A, Verma IC. Spectrum of mutations in homozygous familial hypercholesterolemia in India, with four novel mutations. Atherosclerosis 2016;255:31-6. DOI: https://doi.org/10.1016/j.atherosclerosis.2016.10.028
  8. Gilroy R, Heronemus M, Schmitt T, Moriarty P. Donors with familial hypercholesterolemia and clinical outcome in liver transplant recipients. Transplantation 2014;98:796. DOI: https://doi.org/10.1097/00007890-201407151-02729
  9. Popescu I, Habib N, Dima S, et al. Domino liver transplantation using a graft from a donor with familial hypercholesterolemia: seven-yr follow-up. Clin Transplant 2009;23:565-70. DOI: https://doi.org/10.1111/j.1399-0012.2008.00935.x
  10. Liu C, Niu DM, Loong CC, et al. Domino liver graft from a patient with homozygous familial hypercholesterolemia. Pediatr Transplant 2010;14:E30-3. DOI: https://doi.org/10.1111/j.1399-3046.2009.01133.x
  11. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195-207. DOI: https://doi.org/10.1056/NEJMoa0807646
  12. He K, Wang J, Shi H, et al. An interspecies study of lipid profiles and atherosclerosis in familial hypercholesterolemia animal models with low-density lipoprotein receptor deficiency. Am J Transl Res 2019;11:3116-27.

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2024 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.