Abdominal transplantation candidates have a significantly higher risk for obstructive coronary artery disease than the general population. However, there is no consensus on pre-transplantation screening for coronary artery disease nor methods for determining the perioperative risk in transplantation candidates (Diaz and O'Connor, 2011).

Vascular complications after solid-organ transplantation are not uncommon and may lead to graft dysfunction and ultimately graft loss (Khaja et al., 2014). Single centre data of 3,129 consecutive kidney transplantations reported vascular complications in 13.5%, with Transplant Renal Artery Stenosis (TRAS) being the most common complication (78%) (Bessede et al., 2012). Meanwhile, mTOR inhibitors have been shown to attenuate allograft vasculopathy progression in heart transplant patients (De Simone et al., 2017b).

Liver transplantation patients have an increased risk of cardiovascular events with risk factors including age, pre-transplant disease, diabetes mellitus, metabolic syndrome and hyperuricaemia, dyslipidaemia and obesity. Optimal immunosuppression regimens for the mitigation of cardiovascular disease remains unclear but current recommendations suggest the reduction or elimination of CNI exposure by switching to mTOR inhibitor or MMF/MPA monotherapy (De Simone et al., 2017b). Interestingly given the links between cardiovascular events and obesity, recent data has indicated that everolimus with reduced-exposure tacrolimus may lessen weight gain in liver transplantation patients. At month 24, the standard-exposure tacrolimus group had a mean weight increase of 9.54 kg (± 10.21 kg) compared with 6.69 kg (± 8.37 kg; P=0.011) in the everolimus group (Charlton et al., 2017). Meanwhile, a retrospective review of 69 liver transplant recipients treated with HMG-CoA reductase inhibitors showed a relatively low incidence of adverse events (8.6%) with five (7.2%) reporting myalgia and one (1.4%) with myopathy (Martin et al., 2008).