Targeting Trimethylamine N-Oxide for Cardiovascular Health In Liver Transplant Recipients

Despite medical and surgical advances, long-term survival in liver transplant (LT) recipients is compromised by an increased risk of cardiovascular disease (CVD) after transplant, the mechanisms of which are still not fully understood. Following LT, patients have an increased incidence of atherosclerotic CVD. Notably, atherosclerotic CVD is an established risk factor for diastolic dysfunction and incident heart failure with preserved ejection fraction (HFpEF). There is a critical need to better understand the biological mechanisms of LT related vascular dysfunction and establish targeted interventions that will reduce the risk of CVD in this patient population. In the general population, there is strong epidemiological evidence linking high TMAO levels with atherosclerotic CVD and heart failure, and that it can modulated rapidly by diet within two weeks. Therefore, the purpose of this study is to better understand the role of TMAO in cardiovascular dysfunction patients with chronic kidney disease.

Inclusion criteria

• Aged > 18 years
• Speak and understand English
• Have received and LT

Exclusion criteria

• Acute cellular or chronic rejection within 3 months
• Post-LT liver or non-liver related malignancy
• Active viral hepatitis (B or C) or autoimmune hepatitis
• Untreated biliary strictures or vascular complications (e.g. hepatic artery thrombosis)
• Poorly controlled diabetes (HbA1c >8.5%)
• Relapse of alcohol use after LT
• Follow a vegetarian or vegan diet
• Current pregnancy
• Unable to provide informed consent