Is Liver Transplant Curative in Homozygous Familial Hypercholesterolemia? A Review of Nine Global Cases

Mohammed Al Dubayee*, Meral Kayikcioglu, Jeanine Roeters van Lennep, Nadia Hergli, Pedro Mata

*Corresponding author for this work

Research output: Contribution to journalComment/Letter to the editorAcademicpeer-review

Abstract

Introduction: Homozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening, inherited condition characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C). Patients are at high risk of atherosclerotic cardiovascular disease, adverse cardiovascular events, and associated early mortality. Liver transplant is sometimes used with curative intent. The objective of the current case series was to evaluate the follow-up of a range of patients who have undergone liver transplant for the treatment of HoFH. Methods: Patients with clinical and/or genetic diagnoses of HoFH were treated according to local practices in four units in Europe and the Middle East. All patients underwent liver transplantation. Baseline and long-term follow-up data were collected, including LDL-C levels, DNA mutations, lipid-lowering medications, and complications due to surgery and immunosuppressive therapy. Results: Nine patients were included with up to 22 years’ follow-up (mean ± SD 11.7 ± 11.7 years; range 0.5–28 years). Three of the patients died as a result of complications of transplant surgery (mortality rate 33%). Among the surviving six patients, four required continued lipid-lowering therapy (LLT) to maintain LDL-C levels and two patients show signs of increasing LDL-C levels that require management. One case (11%) required two consecutive transplants to achieve a viable graft and is awaiting a third transplant because of graft failure. Conclusions: Liver transplant did not enable attainment of recommended LDL-C targets in most patients with HoFH, and the majority of patients still required post-transplant LLT. Liver transplant was not curative in most of the patients with HoFH followed. Guidelines suggest that transplant is a treatment of last resort if contemporary treatments are not available or possible.

Original languageEnglish
Pages (from-to)3042-3057
Number of pages16
JournalAdvances in Therapy
Volume39
Issue number6
Early online date26 Apr 2022
DOIs
Publication statusPublished - Jun 2022

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