Major Adverse Cardiovascular Events after liver transplantation: A call for a shared definition

Area of Science:

• Cardiology
• Transplantation Medicine
• Clinical Epidemiology

Background:

• Cardiovascular complications are a major cause of death and illness post-liver transplant.
• Existing definitions for Major Adverse Cardiovascular Events (MACE) lack consistency, hindering research comparability.
• Standard cardiovascular frameworks do not fully address the unique risks in liver transplant recipients.

Purpose of the Study:

• To systematically review definitions of MACE used in studies of liver transplant recipients.
• To identify common and variable components of MACE endpoints in the literature.
• To propose a refined, consensus-based definition for MACE in liver transplantation.

Main Methods:

• Systematic review of 49 studies (RCTs, cohort studies, registry analyses) reporting MACE after liver transplantation.
• Extraction and descriptive analysis of data on study design, follow-up, MACE definitions, and endpoint components.
• Evaluation of event frequency, pathophysiology, and prognostic relevance for proposed MACE components.

Main Results:

• No studies used the classical three-point MACE definition (myocardial infarction, stroke, cardiovascular death).
• Components varied widely; myocardial infarction and heart failure were most common (78%), followed by stroke (68%).
• Pulmonary embolism was inconsistently included; heart failure and arrhythmias were frequent but often not ischemic.

Conclusions:

• A proposed MACE definition for liver transplant recipients includes coronary artery disease, stroke, heart failure, arrhythmias, cardiac arrest, and cardiovascular death, with specific criteria for non-fatal events and exclusion of pulmonary embolism.
• This proposed definition requires further consensus and validation through international processes like the Delphi methodology.
• An endorsed framework will enhance comparability, risk stratification, and clinical management in liver transplantation.