Cardiovascular Disease Remains a Major Threat After Kidney and Liver Transplantation Heart | 2026

Introduction

Kidney and liver transplantation substantially improve survival and quality of life in patients with end-stage organ disease. However, cardiovascular disease (CVD) remains a leading cause of long-term morbidity and premature mortality after transplantation. Despite successful graft function, transplant recipients continue to face a substantial burden of cardiovascular complications that extends well beyond the peri-transplant period.

Problem Statement

Although transplantation reduces mortality compared with dialysis or untreated end-stage liver disease, it does not eliminate cardiovascular risk. Kidney and liver transplant recipients remain vulnerable to a broad spectrum of cardiac disorders, including coronary artery disease, heart failure, arrhythmias, valvular disease and pulmonary hypertension. This persistent risk reflects the combined effects of pre-existing cardiometabolic disease, transplant-related metabolic injury and chronic exposure to immunosuppressive therapy, creating a complex and often under-recognized cardiovascular burden.

Summary

This review highlights the persistent and multifactorial cardiovascular risk faced by kidney and liver transplant recipients, emphasizing that transplantation should be viewed as a transition to chronic cardiovascular risk management rather than risk resolution. The authors describe how pre-transplant vascular disease is compounded after transplantation by weight gain, dyslipidaemia, diabetes, hypertension and immunosuppression-related metabolic toxicity, resulting in sustained cardiovascular vulnerability. Importantly, this risk spans multiple cardiac phenotypes, including ischemic heart disease, heart failure, arrhythmias, valvular dysfunction and pulmonary vascular disease, each requiring organ-specific clinical consideration. The review underscores that cardiovascular surveillance in transplant recipients must extend beyond traditional risk assessment and incorporate longitudinal, multidisciplinary care tailored to graft type and metabolic profile. A central message is that long-term transplant success depends not only on graft survival, but also on proactive cardiovascular prevention, early recognition of evolving cardiac disease and coordinated management across transplant, cardiology and metabolic care teams.