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Prognostic Value of Mitral Annular Calcification in Liver Transplant Patients: Implication in Posttransplant Outcomes

Hwa-Young Jang1, Sang-Bin Han, Jun-Hyeop Jeong

  • 1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Transplantation
|March 19, 2024
PubMed

Insights

Mitral annular calcification (MAC) in liver transplant (LT) candidates is linked to higher short-term cardiac events and worse long-term survival, particularly in women. Early identification and management of MAC are vital for improving LT outcomes.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Medicine

Background:

  • Metabolic diseases and aging increase the prevalence of mitral annular calcification (MAC) in liver transplant (LT) candidates.
  • Cardiovascular disease is a leading cause of mortality in LT recipients, yet the impact of MAC remains understudied.
  • This study examines MAC prevalence, associated factors, and its effect on LT outcomes.

Purpose of the Study:

  • To investigate the prevalence of mitral annular calcification (MAC) in liver transplant (LT) candidates.
  • To identify factors associated with MAC in this population.
  • To determine the impact of pre-LT MAC on major adverse cardiac events (MACE) and long-term survival after LT.

Main Methods:

  • A cohort of 4148 LT patients undergoing pretransplant echocardiography from 2008-2019 was analyzed.
  • Multivariate logistic analysis and Shapley additive explanation (SHAP) scores were used to identify significant factors related to MAC.
  • Primary outcome was 30-day MACE; secondary outcome was 5-year cumulative all-cause mortality.

Main Results:

  • MAC was present in 3.0% of patients, associated with age, alcoholic liver disease, chronic kidney disease, hyperuricemia, hypertension, and coronary artery disease.
  • Patients with MAC had significantly higher 30-day MACE rates (adjusted HR 1.67) and poorer cumulative survival (adjusted HR 1.47).
  • Women with MAC showed a markedly poorer long-term survival probability compared to men without MAC (>10 years post-LT).

Conclusions:

  • Pre-LT MAC is associated with increased short-term MACE and reduced long-term survival.
  • Women with MAC represent a particularly high-risk group for adverse outcomes post-LT.
  • Identifying and managing MAC and its risk factors are critical for enhancing post-LT patient survival.
Abstract

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