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The predictive value of revised diastolic dysfunction in outcomes of liver transplantation: A propensity score
Shenghua Bi1, Yueping Jiang1, Wenjun Zhao1
1Gastroenterology Department, The Affiliated Hospital of Qingdao University, Qingdao, China.
Insights
Diastolic dysfunction in liver transplant recipients is linked to worse outcomes. This condition increases cardiovascular risks and mortality post-transplant, highlighting the need for clinical awareness.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Diastolic dysfunction (DD) is an early sign of cirrhotic cardiomyopathy (CCM).
- The 2019 revised CCM criteria include DD.
- Limited research exists on the impact of revised DD criteria on liver transplant (LT) outcomes.
Purpose of the Study:
- To investigate the association between diastolic dysfunction (DD) and post-liver transplantation (LT) outcomes.
- To identify risk factors for adverse cardiovascular events and mortality in LT patients with DD.
Main Methods:
- Retrospective study of 231 patients undergoing LT for decompensated cirrhosis (Jan 2018-Mar 2021).
- Patients were categorized into DD and non-DD groups.
- Propensity score matching (PSM) was used to adjust for confounding factors; follow-up was at least 1 year.
Main Results:
- 153 patients (65.4%) had DD; 19 with DD died within 1 year post-LT.
- After PSM, DD patients showed longer ICU stays, more cardiovascular adverse events (AEs), and higher mortality.
- Independent predictors for AEs included interventricular septum, left atrial volume index, and potassium; predictors for mortality included decreased e', increased NLR, and tumor markers.
Conclusions:
- Cardiac DD is associated with increased perioperative cardiovascular AEs and mortality post-LT.
- Clinicians should consider DD in patients with decompensated cirrhosis undergoing LT.
Background:
Diastolic dysfunction (DD), one of the earliest signs of cirrhotic cardiomyopathy (CCM), is included in the revised 2019 CCM criteria. Nonetheless, relevant research regarding the effects of revised DD on post-liver transplantation (LT) outcomes remains limited.
Methods:
This retrospective study enrolled patients who underwent LT for decompensated cirrhosis, from January 2018 to March 2021. Patients were divided into DD and non-DD groups. Clinical data were collected. Patients were followed up with, for at least 1 year post-LT; cardiovascular adverse events (AEs) and survival status were recorded. Risk factors were identified using 1:2 propensity score matching (PSM), after adjusting for confounding factors. The caliper value was set to 0.02.
Results:
Of 231 patients, 153 were diagnosed with DD (male, 81.8%; mean age, 51.5 ± 9.5 years). Nineteen patients with DD died within 1 year, post-LT. After PSM, 97 and 60 patients were diagnosed with and without DD, respectively. Patients with DD had longer intensive care unit (ICU) stays, higher perioperative cardiovascular AEs, and higher mortality rates than those without DD. In a multivariate analysis, interventricular septum (IVS), left atrial volume index (LAVI), and potassium levels were independent prognostic factors of perioperative cardiovascular AEs, while a decreased early diastolic mitral annular tissue velocity (e'), increased neutrophil-to-lymphocyte ratio (NLR) and tumor markers were predictors of mortality within 1 year post-LT after PSM (P < 0.05).
Conclusion:
Cardiac DD may contribute to perioperative cardiovascular AEs and mortality post-LT. Clinicians should be aware of decompensated cirrhosis in patients with DD.
