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

Josefsson, Axel; Fu, Michael; Allayhari, Pari; Bjornsson, Einar; Castedal, Maria; Olausson, Michael and Kalaitzakis, Evangelos LU (2012) In Liver International 32(8). p.1262-1269
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cirrhosis, cirrhotic cardiomyopathy, heart failure, left ventricular, diastolic dysfunction, liver transplantation, survival
in
Liver International
volume
32
issue
8
pages
1262 - 1269
publisher
Wiley-Blackwell
external identifiers
  • wos:000307722000010
  • scopus:84865182195
ISSN
1478-3231
DOI
10.1111/j.1478-3231.2012.02818.x
language
English
LU publication?
yes
id
97253c3c-67f7-46fe-b7c7-0a9558f6d46e (old id 3191336)
date added to LUP
2012-12-03 07:11:25
date last changed
2017-04-16 03:49:51
@article{97253c3c-67f7-46fe-b7c7-0a9558f6d46e,
  abstract     = {Background &amp; 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 &lt;= 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 &lt; 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.},
  author       = {Josefsson, Axel and Fu, Michael and Allayhari, Pari and Bjornsson, Einar and Castedal, Maria and Olausson, Michael and Kalaitzakis, Evangelos},
  issn         = {1478-3231},
  keyword      = {cirrhosis,cirrhotic cardiomyopathy,heart failure,left ventricular,diastolic dysfunction,liver transplantation,survival},
  language     = {eng},
  number       = {8},
  pages        = {1262--1269},
  publisher    = {Wiley-Blackwell},
  series       = {Liver International},
  title        = {Impact of peri-transplant heart failure & left-ventricular diastolic dysfunction on outcomes following liver transplantation},
  url          = {http://dx.doi.org/10.1111/j.1478-3231.2012.02818.x},
  volume       = {32},
  year         = {2012},
}