Related Experiment Video
Updated: May 5, 2026
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Pre-transplant left ventricular diastolic dysfunction is associated with post transplant acute graft rejection and
Chetan Mittal1, Waqas Qureshi, Sumit Singla
1Department of Internal Medicine, Henry Ford Health Systems, Detroit, MI, USA.
Insights
Pre-transplant diastolic dysfunction (DD) significantly increases the risk of acute cellular rejection (ACR), graft failure, and mortality in liver transplant recipients (LTR). Cardiac evaluation before liver transplantation is crucial for better outcomes.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Science
Background:
- Acute cellular rejection (ACR) is a major cause of graft failure in liver transplant recipients (LTR).
- Diastolic dysfunction (DD) is common in patients with cirrhosis awaiting liver transplantation.
- The relationship between pre-transplant DD and ACR risk remains unclear.
Purpose of the Study:
- To investigate the association between pre-transplant diastolic dysfunction (DD) and the risk of acute cellular rejection (ACR) in liver transplant recipients (LTR).
- To evaluate DD as a predictor of graft failure and all-cause mortality post-liver transplantation.
Main Methods:
- Retrospective analysis of consecutive LTR data from 2000-2010.
- Primary outcome: biopsy-proven ACR. Secondary outcomes: graft failure and all-cause mortality.
- Cox proportional hazard modeling adjusted for covariates to assess DD as a predictor.
Main Results:
- 14.9% of LTR (n=145) had pre-transplant DD.
- DD significantly increased the risk of ACR (HR 10.56), graft failure (HR 2.09), and mortality (HR 1.52).
- Increased risk correlated with DD severity, even after adjusting for multiple risk factors.
Conclusions:
- Pre-transplant diastolic dysfunction is a significant independent predictor of adverse outcomes in LTR.
- Cardiac assessment prior to liver transplantation is vital for identifying high-risk patients.
- Findings underscore the importance of pre-transplant cardiac evaluation to mitigate rejection and improve survival.
Introduction:
Acute cellular rejection (ACR) is a significant cause of morbidity and graft failure in liver transplant recipients (LTR). Diastolic dysfunction (DD) is frequently present in patients with cirrhosis undergoing liver transplantation. However, it is unclear if DD leads to ACR.
Methods:
Data was collected retrospectively for consecutive LTR between January 2000 and December 2010. Demographic data and mortality related data was obtained from social security index. Primary outcome was biopsy proven ACR. Graft failure and all-cause mortality were also evaluated. DD was evaluated as a predictor of these outcomes. Other echocardiographic indices were also assessed as predictors of ACR by using Cox proportional hazard modeling adjusted for covariates.
Results:
A total of 970 LTR (mean age 53.2 ± 10 years, women 34.6 % and white 64.5 %) were followed for 5.3 ± 3.4 years. Patients with DD (n = 145, 14.9 %) were significantly more likely to develop ACRs (HR 10.56; 95 % CI 6.78-16.45, p value = 0.0001) as well as graft failure (HR 2.09; 95 % CI 1.22-3.59, p value = 0.007) and all-cause mortality (HR 1.52; 95 % CI 1.08-2.13, p = 0.01). There was an increase in the risk of these outcomes with worsening of DD, when adjusted for various risk factors such as donor and recipient age, gender, race, Framingham risk score, pre-transplant MELD, transplant etiology and cold ischemia time.
Conclusion:
Pre-transplant DD is significantly associated with increased risk of allograft rejection, graft failure and mortality. This signifies the importance of cardiac evaluation during the pre-transplant period.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:28Kidney Transplant I: Introduction
01:22Mitral Stenosis I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:29Heart Failure II: Pathophysiology
01:29Cardiomyopathy V: Interprofessional Care