LAUSR

To the editor, Liver transplantation (LT) recipients have an increased risk of developing cardiovascular disease (CVD), but the physiological mechanisms driving this risk are not yet fully understood. A decline in renal function after transplant may be an important contributor to the development of CVD among these patients. In this regard, a recent article published in Liver Transplantation by Hassouneh et al. demonstrated that estimated glomerular filtration rate (eGFR) 6 months following LT was a strong predictor of future atherosclerotic events and that the addition of eGFR to the Framingham Risk Score improved CVD risk stratification among LT recipients.[1] Vascular dysfunction characterized by endothelial dysfunction and arterial stiffness have previously been documented as the initial pathophysiological events in the development of atherosclerosis and are common characteristics observed with declining renal function.[2] Renal function decline after LT may lead to endothelial dysfunction and arterial stiffness, which may accelerate the development of atherosclerotic CVD. The association between altered renal function and vascular dysfunction after LT has not yet been investigated. Therefore, following the work of Hassouneh et al., we performed a series of physiology‐ based assessments to ascertain if vascular dysfunction may be a potential therapeutic target to mitigate CVD risk in patients with renal dysfunction following LT.