The Pre-Transplant Profile of Cardiovascular Risk Factors and Its Impact on Long-Term Mortality After Liver Transplantation
Renata Główczyńska, Michalina Galas, Anna Witkowska, Urszula Ołdakowska-Jedynak, Joanna Raszeja-Wyszomirska, Krzysztof Krasuski, Piotr Milkiewicz, Marek Krawczyk, Krzysztof Zieniewicz, Grzegorz Opolski
1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Ann Transplant 2018; 23:591-597
Cardiovascular disease (CVD) is an important aggravating factor for orthotopic liver transplantation (OLT) outcomes. CVD still seems to be one of the most common cause of death in the long-term post-transplant period. Nevertheless, there are some limited data regarding the optimal strategy of risk assessment during OLT candidate evaluation.
MATERIAL AND METHODS: Routine pre-transplant cardiac workup in 360 patients with end stage liver disease (ESLD) included electrocardiogram, echocardiography, and exercise stress testing. The aim of this retrospective study was an analysis of the impact of cardiovascular risk profile on overall mortality in the 2-year follow-up of 160 patients who underwent liver transplantation.
RESULTS: Cardiovascular risk factors or a history of CVD were found in 23.1% of patients who received transplants. The cardiovascular risk factors most common in our group of transplant recipients with ESLD were: diabetes (26.3%), hypertension (25.6%), and hepatopulmonary syndrome (23.1%). Only 3.8% of patients had a positive exercise test. Coronary angiography revealed at least 50% stenosis in some epicardial arteries in 1.9% of patients. The risk of death in long-term follow-up of liver transplant recipients was most strongly associated with 3 cardiac variables: history of coronary artery disease (CAD), angiographically confirmed coronary stenosis, and reduced ejection fraction (EF).
CONCLUSIONS: Our study identified pre-transplant CAD with its consequences as a factor associated with increased risk of negative post-transplant outcomes.
Keywords: Cardiovascular Diseases, End stage liver disease, Liver Transplantation, Risk Factors