Short-Term Cardiac and Noncardiac Mortality Following Liver Transplantation

Abstract

Objectives. To determine the importance of acute cardiac events as a cause of mortality compared to non-cardiac events in the four month period following liver transplantation (LT) using current preoperative cardiac screening strategies. Patients and Methods. We retrospectively reviewed timing, type, and outcome of adverse cardiac events, and all cause mortality in the 4 month postoperative period in 393 consecutive LT patients from October 1999 to February 2008. Results. Of 30 total deaths (7.6% overall mortality rate), 27 (90%) were due to surgical or medical complications and 3 (10%) were primary cardiac deaths (0.8% cardiac mortality rate). Acute cardiac events occurred in 26 patients (6.6%), including 13 arrhythmias (50%), 7 new onset heart failures (27%), and 6 myocardial infarctions (23%). Twelve of 13 intraoperative events were arrhythmias (92%) including two of three cardiac deaths. Conclusions. Using current preoperative screening recommendations, deaths from primary cardiac events within four months of LT are very uncommon (0.8%), especially compared with deaths related to medical and surgical complications (6.9%).

Adverse cardiac events after orthotopic liver transplantation: A cross‐sectional study in 389 consecutive patients

“…The dobutamine stress test was used as the primary screening tool for cardiac risk stratification at our institution . Despite conflicting published data, our results show that a target DSE does not effectively identify the few patients who will have adverse cardiac events during the first year after OLT.…”

Liver Transplantation in Recipients Receiving Renal Replacement Therapy: Outcomes Analysis and the Role of Intraoperative Hemodialysis

“…Although the reasons for increased short‐term mortality are multifactorial, we believe that intraoperative complications such as cardiac arrhythmias, PRS and coagulopathy have contributed. PRS and intraoperative arrhythmias have been shown to be risk factors for increased postoperative complications, poor liver allograft function, graft loss, retransplantation and mortality following LT . Patients with renal failure requiring RRT have an increased incidence of electrolyte and acid/base disturbances making them particularly susceptible to arrhythmias, PRS and coagulopathy during LT .…”

Transplant of Elderly Patients

“… 33 Patients older than 50 years have a higher cardiac event rate of 7.5% (compared with 5.1% in younger patients) and a mortality of 0.8% to 1.2%. 33 , 34 Intraoperative complications could be higher than the reported rates because the data are possibly biased by the strict selection and may not apply to all elderly transplant candidates. Nonetheless, advanced age and NASH seem to have a negative impact on the early post-LT survival because of higher rates of cardiovascular events.…”