The Pre-Transplant Profile of Cardiovascular Risk Factors and Its Impact on Long-Term Mortality After Liver Transplantation

Abstract

BackgroundCardiovascular disease (CVD) is an important aggravating factor for orthotopic liver transplantation (OLT) outcomes. CVD still seems to be one of the most common cause of death in the long-term post-transplant period. Nevertheless, there are some limited data regarding the optimal strategy of risk assessment during OLT candidate evaluation.Material/MethodsRoutine pre-transplant cardiac workup in 360 patients with end stage liver disease (ESLD) included electrocardiogram, echocardiography, and exercise stress testing. The aim of this retrospective study was an analysis of the impact of cardiovascular risk profile on overall mortality in the 2-year follow-up of 160 patients who underwent liver transplantation.ResultsCardiovascular risk factors or a history of CVD were found in 23.1% of patients who received transplants. The cardiovascular risk factors most common in our group of transplant recipients with ESLD were: diabetes (26.3%), hypertension (25.6%), and hepatopulmonary syndrome (23.1%). Only 3.8% of patients had a positive exercise test. Coronary angiography revealed at least 50% stenosis in some epicardial arteries in 1.9% of patients. The risk of death in long-term follow-up of liver transplant recipients was most strongly associated with 3 cardiac variables: history of coronary artery disease (CAD), angiographically confirmed coronary stenosis, and reduced ejection fraction (EF).ConclusionsOur study identified pre-transplant CAD with its consequences as a factor associated with increased risk of negative post-transplant outcomes.

Global Longitudinal Strain at Rest as an Independent Predictor of Mortality in Liver Transplant Candidates: A Retrospective Clinical Study

“…For liver transplant recipients, heart diseases are an important risk factor for perioperative mortality [1]. Approximately 7-21% of deaths following liver transplantation are related to cardiovascular events [2].…”

Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

“…The standard pre-LT work-up includes electrocardiogram and transthoracic echocardiography [6], in order to identify cardiac disorders that, untreated, would worsen the LT outcome. In addition, patients older than 50 years, or with cardiovascular risk factors (hyperlipidemia, hypertension, diabetes, and smoking), should undergo noninvasive stress testing and cardiologic evaluation, in order to assess underlying coronary artery disease [6,8,27]. Patients with proven ischemia from the stress test (for example: stress echocardiography with dobutamine) are referred to the multidisciplinary team for further investigations, like coronary angiography with revascularization, if there is more than 70% coronary artery obstruction [23].…”

“…A recently published study [27] demonstrated that the prevalence of traditional CV risk factors among LT patients is around 23%; the most common being hypertension and diabetes. However, studies failed to demonstrate a significant association between the risk factors and mortality, due to CV events within the first 30 days after LT [14].…”

“…However, studies failed to demonstrate a significant association between the risk factors and mortality, due to CV events within the first 30 days after LT [14]. Several characteristics were associated with the risk of death long-term following LT: presence of coronary artery disease, with stenosis at coronarography and reduced ejection fraction (less than 50%), and portal vein thrombosis [27]. It has also been reported that the donor’s features influenced the perioperative mortality due to CV events: high donor body mass index, deceased vs. living donor, and cardiac death of the donor [14].…”

Cardiovascular Evaluation of Liver Transplant Patients by Using Coronary Calcium Scoring in ECG-Synchronized Computed Tomographic Scans

“…There is no consensus on the preferred screening test to detect CAD in the pre-LT population nor for post-LT cardiac evaluation. The methods of cardiac assessment differ from site to site [ 3 , 8 , 17 ]. The American Heart Association and the American College of Cardiology Foundation suggest non-invasive stress testing following cardiovascular risk assessment for patients without active cardiac disease [ 18 ].…”