Impact of cardiac dysfunction on morbidity and mortality in liver transplant candidates

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Cardiac dysfunction is increasingly recognized as a significant factor in cirrhotic patients.
• Its prognostic role, particularly concerning morbidity and mortality before and after liver transplantation (LT), requires thorough investigation.
• The development of post-transplant cardiovascular disease (CVD) in this population is also a critical concern.

Purpose of the Study:

• To determine the prevalence of cardiac dysfunction in patients undergoing LT assessment.
• To analyze the impact of cardiac dysfunction on morbidity and mortality before and after LT.
• To investigate the association between cardiac dysfunction and the development of post-transplant CVD.

Main Methods:

• Retrospective review of 308 cirrhotic patients assessed for LT between January 2010 and December 2020.
• Analysis of demographics, cardiac investigations, and clinical outcomes.
• Survival analysis using Cox proportional hazard regression, with LT as a time-varying covariate and interaction variable.

Main Results:

• Cardiac dysfunction was present in 58% of patients, predominantly diastolic dysfunction.
• Cardiac dysfunction was significantly associated with hepatorenal syndrome/acute kidney injury and peri- and post-transplant morbidity (aORs ranging from 1.9 to 2.01).
• No significant association was found between cardiac dysfunction and mortality before or after LT, or with post-transplant CVD.

Conclusions:

• Cardiac dysfunction is highly prevalent in LT candidates and is a significant predictor of increased peri- and post-transplant morbidity.
• Cardiac dysfunction does not appear to influence mortality or the development of post-transplant CVD.
• Further research utilizing advanced echocardiographic parameters is needed to refine diagnosis and optimize LT outcomes.