Impact of cardiac dysfunction on morbidity and mortality in liver transplant candidates

Diastolic dysfunction: Prevalence and outcome in liver transplantation candidates

INTRODUCTION AND OBJECTIVES

Cirrhotic cardiomyopathy (CCM) is a cardiac complication of cirrhosis primarily presenting as diastolic dysfunction (DD). The original diagnostic criteria from 2005 were updated in 2019. This retrospective study aimed to determine the prevalence and clinical impact of DD in liver transplantation (LT) candidates.

MATERIALS AND METHODS

Data from 233 adult cirrhotic LT candidates were analyzed, and echocardiographic data were used to define DD in all patients using the original criteria and the revised criteria.

RESULTS

The prevalence of DD was 72,1 % using the original criteria for DD and 6,4 % using the revised criteria. Patients with DD according to the revised criteria were older than those without DD. Other clinical characteristics were similar between groups. Waitlist mortality was 13,3 % in patients with DD versus 9,2 % in patients without DD (NS), according to the revised criteria. A similar percentage of patients with DD (80 %) underwent LT compared to patients without DD (89 %). Post-LT survival rates were comparable between patients with DD (87,3 % by original criteria, 91,7 % by revised criteria) and patients without DD (81,3 % by original and 85,6 % by revised criteria). Notably, lower e' lateral values pre-LT were associated with post-LT mortality. Major adverse cardiovascular events post-transplantation occurred in 16,7 % of patients with pre-LT DD and in 13,9 % of patients without pre-LT DD (NS).

CONCLUSIONS

According to the revised criteria, 6,4 % of LT candidates in this cohort had DD. The presence of DD did not significantly impact overall post-transplant mortality.

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

BACKGROUND

With the rise of metabolic diseases and aging in liver transplant (LT) candidates, mitral annular calcification (MAC) is more recognizable. Despite cardiovascular risk becoming a leading cause of mortality in LT recipients, the influence of MAC remains unexamined. This study investigates the prevalence, related factors, and impact of MAC on LT outcomes.

METHODS

We explored 4148 consecutive LT patients who underwent routine pretransplant echocardiography from 2008 to 2019. Multivariate logistic analysis and the tree-based Shapley additive explanation scores in machine learning were used to evaluate the significant and important related factors. The primary outcome was 30-d major adverse cardiac events (MACE), and the secondary outcome was a median of 5-y cumulative all-cause mortality.

RESULTS

MAC was found in 123 (3.0%) patients. Significant and important related factors included age, alcoholic liver disease, chronic kidney disease, hyperuricemia, hypertension, and coronary artery disease. The MACE rate was higher in patients with MAC compared with those without MAC at 30 d ( P  < 0.001, adjusted hazard ratio 1.67; 95% confidence interval, 1.08-2.57). Patients with MAC had poorer cumulative overall survival probability compared with those without MAC ( P  = 0.0016; adjusted hazard ratio 1.47; 95% confidence interval, 1.01-2.15). Specifically, women with MAC had a poorer survival probability compared with men without MAC (65.0% versus 80.7%, P  < 0.001) >10 y post-LT.

CONCLUSIONS

The presence of MAC before LT was linked to increased 30-d MACE and lower long-term survival rates, especially in women. Identification and management of MAC and potential risk factors are crucial for improving post-LT survival.

The role of echocardiographic assessment for the risk of adverse events in liver transplant recipients: A systematic review and meta-analysis

BACKGROUND & AIMS

Echocardiographic findings may provide valuable information about the cardiac conditions in cirrhotic patients waiting for liver transplantation (LT). However, data on the ability of the different echocardiographic parameters to predict post-transplant risk of mortality are scarce and heterogeneous. This systematic review evaluates the role of different echocardiographic features as predictors of post-LT mortality. A meta-analysis was also performed according to the observed results.

METHODS

A systematic review was conducted according to PRISMA guidelines. Medline (PubMed) database was searched through February 2023 for relevant published original articles reporting the prognostic value of echocardiographic findings associated with outcomes of adult LT recipients. The risk of bias in included articles was assessed using ROBINS-E tool. Methodological quality varied from low to high across the risk of bias domains.

RESULTS

Twenty-three studies were identified after the selection process; ten were enrollable for the meta-analyses. According to the results observed, the E/A ratio fashioned as a continuous value (HR = 0.43, 95%CI = 0.25-0.76; P = 0.003), and tricuspid regurgitation (HR = 2.36, 95%CI = 1.05-5.31; P = 0.04) were relevant predicting variables for post-LT death. Other echocardiographic findings failed to merge with statistical relevance.

CONCLUSION

Tricuspid regurgitation and left ventricular diastolic dysfunction play a role in the prediction of post-LT death. More studies are needed to clarify further the impact of these echocardiographic features in the transplantation setting.