Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years

Area of Science:

• Transplantation Medicine
• Cardiovascular Medicine
• Public Health

Background:

• Liver transplantation (LT) has seen advancements in surgical and post-transplant care.
• Cardiovascular (CV) mortality is a critical concern in LT recipients, impacting long-term survival.
• Understanding trends in CV mortality is essential for improving patient outcomes.

Purpose of the Study:

• To investigate the impact of evolving LT therapies on cardiovascular mortality.
• To analyze early (≤30 days) and late (>30 days) CV mortality trends over three decades.
• To identify predictors of CV mortality in the liver transplant population.

Main Methods:

• Retrospective cohort study of adult LTs in Australia and New Zealand (1985-present).
• Analysis of 4265 patients with 37,409 person-years of follow-up.
• Multivariable Cox regression to identify predictors of early and late CV mortality.

Main Results:

• Overall CV mortality decreased significantly across transplant eras (P < 0.001).
• CV causes remained the leading cause of early mortality (~40% in the contemporary era).
• Coronary artery disease and transplant era predicted early CV mortality; age predicted late CV mortality.

Conclusions:

• Despite reductions, CV mortality remains a substantial cause of early and late deaths post-LT.
• CV deaths occur significantly later than non-cardiac deaths.
• Longitudinal follow-up is vital for implementing risk-reduction strategies in LT patients.