Liver transplantation for homozygous familial hypercholesterolemia: a retrospective analysis from Chinese experience

Hao-Su Zhan; Lin Wei; Wei Qu; Zhi-Gui Zeng; Ying Liu; Yu-Le Tan; Jun Wang; Liang Zhang; En-Hui He; Guang-Peng Zhou; Hai-Ming Zhang; Zhi-Jun Zhu; Li-Ying Sun

doi:10.1186/s13023-024-03443-z

Liver transplantation for homozygous familial hypercholesterolemia: a retrospective analysis from Chinese experience

Orphanet J Rare Dis. 2025 Jan 15;20(1):26. doi: 10.1186/s13023-024-03443-z.

Authors

Hao-Su Zhan^#^{1

2

3}, Lin Wei^#^{2

3

4}, Wei Qu^{2

3

4}, Zhi-Gui Zeng^{2

3

4}, Ying Liu^{1

2

3

4}, Yu-Le Tan^{2

3}, Jun Wang^{2

3}, Liang Zhang^{2

3

5}, En-Hui He^{2

3

6}, Guang-Peng Zhou^{2

3

4}, Hai-Ming Zhang^{2

3

4}, Zhi-Jun Zhu^{7

8

9}, Li-Ying Sun^{10

11

12

13}

Affiliations

¹ Department of Critical Liver Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
³ Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.
⁴ Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
⁵ Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁶ Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁷ Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China. zhu-zhijun@outlook.com.
⁸ Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China. zhu-zhijun@outlook.com.
⁹ Laboratory for Clinical Medicine, Capital Medical University, Beijing, China. zhu-zhijun@outlook.com.
¹⁰ Department of Critical Liver Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China. sunxlx@outlook.com.
¹¹ Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China. sunxlx@outlook.com.
¹² Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China. sunxlx@outlook.com.
¹³ Laboratory for Clinical Medicine, Capital Medical University, Beijing, China. sunxlx@outlook.com.

^# Contributed equally.

PMID: 39815304
DOI: 10.1186/s13023-024-03443-z

Abstract

Background: Homozygous familial hypercholesterolaemia (HoFH) increases risk of premature cardiovascular events and cardiac death. In severe cases of HoFH, clinical signs and symptoms cannot be controlled well by non-surgical treatments, liver transplantation (LT) currently represents the viable option.

Method: To assess the clinical efficacy, prognosis, and optimal timing of LT for HoFH, a retrospective analysis was conducted on the preoperative, surgical conditions, and postoperative follow-up of children who received an LT for HoFH at the Beijing Friendship Hospital over the period from December 2014 to August 2022.

Results: Xanthoma and decreased activity tolerance were the primary clinical manifestations in the 7 HoFH children initially assessed (one child died suddenly prior to surgery due to cardiac arrest). Accompanying these symptoms were increased blood total cholesterol (TC) and low density lipoprotein (LDL) levels, along with severe cardiovascular diseases. HoFH was confirmed in all cases by genetic and biochemical assays. Initial treatments administered to these patients consisted of low-fat diets and lipid-lowering drugs with poor outcomes. Accordingly, all 6 patients received orthotopic liver transplantations (OLT), with the result that significant postoperative reductions were observed in levels of TC and LDL. The median follow-up of these six cases was 37.41 months (range: 19.40-94.10 months). Regular postoperative follow-ups revealed that all survived and showed significant improvements in their clinical symptoms.

Conclusion: So far, LT is the only way to heal HoFH. LT before the appearance of obvious cardiovascular atherosclerotic lesions can significantly improve the quality of life and prognosis of patients. At the same time, the blood cholesterol level of patients should be continuously monitored after LT to further control the progression of vascular complications.

Keywords: Cardiovascular disease; Children; Homozygous familial hypercholesterolemia; Liver transplantation; Long-term prognosis; Metabolic liver disease.