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Published on: November 7, 2020
Risk Factors and Cardiovascular Events in Orthotopic Liver Transplantation
Asghar Ali1, Brian Mitchell2, Robert Donovan1
1Department of Medicine McGuire Veterans' Affairs Medical Center, Richmond, VA; Department of Medicine Virginia Commonwealth University, Richmond, VA, USA.
Insights
Liver transplant recipients face significant cardiovascular risks. Pre-existing conditions like coronary artery disease predict mortality, while new-onset hypertension and diabetes are key post-transplant risks.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Liver transplant candidates often present with substantial cardiovascular risk factors.
- Post-transplant cardiac morbidity and mortality are significant concerns in this population.
Purpose of the Study:
- To determine the frequency of cardiovascular risk factors in liver transplant recipients.
- To identify predictors of post-transplant cardiac morbidity and mortality.
Main Methods:
- Retrospective study of 261 patients undergoing liver transplantation (1997-2015).
- Evaluation of cardiovascular events and mortality post-transplantation.
- Analysis of pre- and post-transplant risk factors.
Main Results:
- 28.7% of patients died during a median 82-month follow-up; 17.3% of deaths were cardiovascular.
- Coronary events or revascularization occurred in 9.2% of patients.
- Pre-transplant predictors of mortality included age, Framingham risk score, coronary artery disease, and dyslipidemia. Post-transplant predictors included new-onset hypertension and diabetes.
Conclusions:
- Coronary artery disease is a significant mortality predictor in post-liver transplant veterans.
- While coronary artery disease is a factor, most post-transplant deaths stem from other causes.
Background And Aims:
Patients undergoing liver transplantation often have significant cardiovascular risk factors and may experience cardiac-related morbidity and mortality. The aim of this study was to assess the frequency of cardiovascular risk factors and outcomes in this population, and to identify factors predictive of post-transplant cardiac morbidity and mortality.
Methods:
We studied 261 patients who underwent liver transplantation at a single Veterans' Affairs Medical center between 1997 and 2015 to evaluate new cardiovascular events post-transplantation.
Results:
The cohort consisted of 261 patients (253 men and 8 women) with a mean age of 58.3 (± 6.5 years), mean model for end-stage liver disease score of 18.0 (±7.2), and mean Framingham risk score of 8.1 (± 4.9). After a median follow-up of 82 months a total of 75 (28.7%) patients died, with 13 deaths (17.3%) attributed to a primary cardiovascular event and 9 (12%) deaths due to a coronary-specific event. Coronary events and/ or the need for revascularization post-transplant occurred in 24 (9.2%) patients. The strongest pre-transplant predictors of mortality were age (p=0.01), Framingham risk score (p=0.01), preexisting coronary artery disease (p=0.01), and preexisting dyslipidemia (p=0.01). The strongest post-transplant predictors of mortality were new-onset hypertension (p=0.01) and new-onset diabetes mellitus (p=0.03) post-transplant.
Conclusions:
In this cohort of veterans, coronary artery disease was significantly associated with mortality in the post liver transplantation population; however, the majority of deaths after transplant were attributable to other causes.
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