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Published on: April 27, 2019
Pre-Liver Transplant Transthoracic Echocardiogram Findings and 6-Month Post-Transplant Outcomes: A Case-Control
Monica A Konerman1, Jennifer C Price1, Catherine Y Campbell2
1Department of Internal Medicine, Division of Gastroenterology, Johns Hopkins Hospital/University School of Medicine, Baltimore, MD, USA.
Insights
Pre-transplant echocardiograms can identify liver transplant candidates at high risk for cardiopulmonary complications. Incomplete assessment of right ventricular systolic function and mitral regurgitation are key indicators of poor outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Cardiopulmonary (CP) complications are a major cause of death after liver transplantation (LT).
- Effective risk stratification for CP complications in LT candidates is needed.
- Pre-operative transthoracic echocardiogram (TTE) findings may predict post-LT outcomes.
Purpose of the Study:
- To assess the association between pre-LT TTE findings and 6-month post-LT outcomes.
- To identify specific TTE parameters indicative of CP risk.
- To improve risk stratification for LT candidates.
Main Methods:
- Retrospective analysis of adult LT recipients (n=76).
- Comparison of patients who died within 6 months (cases) versus survivors (controls).
- Subgroup analysis based on cause of death (CP vs. non-CP).
Main Results:
- ≥ Mild mitral regurgitation (OR 3.44) and incomplete right ventricular systolic function (RVSF) assessment (OR 24) were associated with increased 6-month mortality.
- These associations were significant in patients with a CP cause of death.
- Patients with CP deaths had poorer RVSF assessment and lower RV fractional area change.
Conclusions:
- Pre-LT TTE parameters, including mitral regurgitation and RVSF assessment, are associated with early post-LT mortality.
- Adequate assessment of these CP parameters is crucial for risk stratification.
- TTE findings can guide pre-transplant management and improve patient selection.
Abstract:
BACKGROUND Cardiopulmonary (CP) outcomes remain a leading cause of morbidity and mortality following liver transplantation (LT). The optimal CP risk stratification of LT candidates remains unclear. The aim of this study was to evaluate the association of pre-LT transthoracic echocardiogram (TTE) findings and 6-month post-LT outcomes. MATERIAL AND METHODS This retrospective review analyzed adults who underwent LT, comparing those who died within 6 months of LT (cases; n=38) with age- and sex-matched patients who survived >6 months (controls; n=38). Cases were categorized by cause of death (COD) defined as either a primary CP process (n=20) or a non-CP process (n=18). Data were analyzed using logistic regression and survival analysis was performed using Kaplan-Meier curves. RESULTS There was a higher odds of death within 6 months of LT with ≥ mild mitral regurgitation (OR 3.44, p=0.03) or an incomplete assessment of right ventricular systolic function (RVSF) (OR 24, p=0.004). On subgroup analysis, these findings only persisted in patients with a CP COD. Patients with CP COD were older (61 vs. 54.5, p=0.04), had longer intervals between TTE and LT (122 vs. 29 days, p=0.05), less complete assessments of RVSF (p=0.009), and lower RV fractional area change (p=0.04) compared to patients with non-CP COD. CONCLUSIONS Multiple TTE parameters were associated with patients who died within 6 months of LT, and in particular patients with a CP COD. Our findings suggest that pre-LT TTEs can convey useful CP risk stratification information and emphasizes the importance of adequately assessing these parameters prior to LT.
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