Characteristics, Risk Factors, and Outcome of New-onset Systolic Heart Failure After Liver Transplantation: A Single-center Cohort

Abstract

C ardiovascular complications are rampant after liver transplantation (LT). 1,2 Among this plethora of complications, systolic heart failure (HF) constitutes a distinct and important clinical entity in the first posttransplant year, with a reported incidence as high as 14% and associated mortality of 33%-45%. [3][4][5] Despite its devastating effect on the survival and quality of life of recipients, HF remains poorly understood. Regrettably, 2 decades of research into the diagnostic, therapeutic, and preventive strategies of post-LT myocardial dysfunction have provided scant data regarding its etiology, characteristics, and prognosis. 6,7 Thus, there remains a dire need to fill this knowledge gap so that the loss of both lives and grafts can be minimized.Systolic HF is also aptly referred to as HF with reduced ejection fraction (EF). The new universal definition of HF requires the left ventricular EF (LVEF) to be <50%, which includes reduced (<40%) and mildly reduced EF (41%-49%) categories. 8 Nonetheless, right ventricular (RV) dysfunction also plays a crucial role in the hemodynamics and prognosis of HF. 9 Although several etiologies and predictors of HF after LT has been proposed, 3,5,10 these reports mainly focused on early nonischemic systolic LV dysfunction and overlooked the roles of ischemic etiologies and RV in post-LT HF. [3][4][5]7,[10][11][12][13][14] An additional understanding of cardiac dysfunction after LT is