Impact of peri-transplant heart failure & left-ventricular diastolic dysfunction on outcomes following liver transplantation

Axel Josefsson*, Michael Fu, Pari Allayhari, Einar Björnsson, Maria Castedal, Michael Olausson, Evangelos Kalaitzakis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)

Abstract

Background & Aims: Assess the prevalence of peri-transplant heart failure and its potential relation to post-transplant morbidity and mortality. Methods: A retrospective study was performed on 234 consecutive cirrhotic patients undergoing liver transplantation in a single European center from 1999 to 2007 (mean age 52, 30% women, 36% with alcoholic liver disease, 24% with viral hepatitis, 18% cholestatic liver disease). Left ventricular diastolic dysfunction was defined as E/A ratio ≤ 1. We used the Boston classification for heart failure to assess the prevalence of peri-transplant heart failure. Patients were followed up for a mean of 4 years post-transplant (0.5-9 years). Results: Eighteen per cent of patients demonstrated diastolic dysfunction pretransplant. During the peri-transplantation period highly possible heart failure occurred in 27%. In logistic regression analysis, heart failure was independently related to lower mean arterial blood pressure (OR 0.94, 95% CR 0.91-0.98) and prolonged corrected QT time on ECG (OR 9.10, 95% CI 3.77-21.93) pretransplant. Peri-transplant mortality amounted to 5%, and was independently related to heart failure (OR 15.11, 95% CI 1.76-129.62) and the peri-transplant need of dialysis (OR 14.18, 95% CI 1.65-121.89). Heart failure was also associated with longer stay in the intensive care unit and peri-transplant cardiac events (P < 0.05). Long-term transplant-free mortality was independently related to diastolic dysfunction at baseline (Hazard ratio 4.82, 95% CI 1.78-13.06). Conclusion: Heart failure occurs in approximately a quarter of patients with cirrhosis following liver transplantation and it is an independent predictor of mortality and morbidity.

Original languageEnglish
Pages (from-to)1262-1269
Number of pages8
JournalLiver International
Volume32
Issue number8
DOIs
Publication statusPublished - Sept 2012

Other keywords

  • Cirrhosis
  • Cirrhotic cardiomyopathy
  • Heart failure
  • Left ventricular diastolic dysfunction
  • Liver transplantation
  • Survival

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