Objectives of this study were (1) to evaluate preoperative predictors of systolic and diastolic heart failure in patients undergoing liver transplantation (LT) and (2) to describe the prognostic implications of systolic and diastolic heart failure in these patients. The onset of heart failure after orthotopic LT remains poorly understood. Data were obtained for all LT recipients between January 2000 and December 2010. The primary outcome was post-LT heart failure: systolic (ejection fraction 50%), diastolic, or mixed heart failure. Patients underwent echocardiographic evaluation before and after LT. Pretransplant variables were evaluated as predictors of heart failure with Cox proportional hazards model. 970 LT recipients were followed for 5.3 6 3.4 years. Ninety-eight patients (10.1%) developed heart failure in the posttransplant period. There were 67 systolic (6.9%), 24 diastolic (2.5%), and 7 mixed systolic/diastolic (0.7%) heart failures. Etiology was ischemic in 18 (18.4%), tachycardia-induced in 8 (8.2%), valvular in 7 (7.1%), alcohol-related in 4 (4.1%), hypertensive heart disease in 3 (3.1%), and nonischemic in majority of patients (59.2%). Pretransplant grade 3 diastolic dysfunction, diabetes, hypertension, mean arterial pressure 65 mm Hg, mean pulmonary artery pressure 30 mm Hg, mean pulmonary capillary wedge pressure 15 mm Hg, hemodialysis, brain natriuretic peptide level and QT interval > 450 ms were found to be predictive for the development of new-onset systolic heart failure. However beta-blocker use before LT and tacrolimus after LT were associated with reduced development of new-onset systolic heart failure. In conclusion, pretransplant risk factors, hemodynamic variables, and echocardiographic variables are important predictors of post-LT heart failure. In patients undergoing LT, postoperative onset of systolic or diastolic heart failure was found to be an independent predictor of mortality.

Background: Atrial fibrillation (AF) is emerging as a major health problem. The prevalence is as high as 32% in patients with renal disease. Gastrointestinal bleeding (GIB) is a frequent complication. Objective: To investigate the hazards of resumption or discontinuation of anticoagulation in renal disease patients after an episode of GIB. Design, settings, participants and measurements: This is a multicenter retrospective cohort of patients with AF on warfarin that developed an episode of GIB. Chronic kidney disease (CKD) was defined by eGFR 60 mL/ min and end stage renal disease (ESRD) was defined by being on hemodialysis for 43 months. Outcomes were 90-day recurrent gastrointestinal bleeding (GIB), mortality, and stroke/transient ischemic attack (TIA). Results: Out of 11,513 AF patients, index GIB occurred in 96 ESRD and 159 CKD patients. Outcomes of CKD patients did not differ when compared with patients with normal kidney function. CKD patients who resumed warfarin had decreased stroke/TIA rates (p50.0001). There were no significant differences between CKD patients who resumed warfarin versus that did not resume warfarin (p40.05). ESRD patients also did not have significant differences in outcomes when compared to patients with normal kidney function restarted on warfarin. However, there was an increase in recurrent GIB and decrease in mortality as well as stroke/TIA when patients with ESRD that restarted warfarin were compared with ESRD patients who did not restart warfarin. Conclusion: Study suggests resuming warfarin after an episode of GIB in CKD patients but recommends considering the increased risk of recurrent GIB in ESRD patients.

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e22184 Background: Heparin induced thrombocytopenia (HIT) is known to be caused by the presence of PF 4 antibody. Tumors exert immunomodulatory effects on the host immune response, including development of antibodies. Our aim was to analyze the presence of HIT in cancer patients and determine if HIT Ab is an adverse risk factor in patients with cancer. Methods: Patients with suspected HIT were selected. A case – control study was designed with 1:1 age and gender matched controls. We used chi – square analysis to compare proportions and Cox proportional hazard model to detect various predictors. Time to survival analysis was performed using Kaplan – Meier method. Results: Of 600 patients, 300 (63±15 years, women 48.8%) had a mean 4T pre – probability score of 4 ± 1.6. There were 132 cancers in both groups. 65 of these (49.2%) were in patients with probable HIT. The numbers of carcinomas and sarcomas were not significantly different between the two groups. There were no significant differences between the two groups when comparing the number of cancer diagnoses or the particular types of cancer diagnosed. The mean time to detection of cancer was within 9 ± 23 months for patients with HIT Ab versus 31 ± 54 months in cancer patients without HIT Ab (p <0.0001). In addition, there was a greater number of patients with at least 2 primary cancers among the HIT Ab positive group (p = 0.003). No predictive relationship between the type of cancer and the presence of HIT Ab was found (p >0.05). Patients with advanced cancer (stage 3 or 4) were also more likely to be HIT Ab positive (HR 3.61; 95% CI 1.31 – 10.11, p = 0.013). Cancer patients with HIT Ab were more likely to have venous thromboembolism as compared to cancer patients without HIT Ab (7.7% vs. 4.7, p = 0.0001). Kaplan – Meier’s showed worse mortality for cancer patients with HIT Ab than patients without the HIT Ab (Breslow statistic = 0.04). Conclusions: Among our cohort with suspected HIT, cancer was a common finding. Patients with HIT antibody positivity were more likely to have a new cancer diagnosis within 1 year of a positive result. These patients were also more likely to have thromboembolic complications and worsened mortality. These findings require further study, but perhaps suggest that the presence of HIT Ab should trigger earlier surveillance for cancer.

Background: With better health care, hematopoietic stem cell transplantation has become possible for older patients. These patients have higher prevalence of diastolic dysfunction. However, it is not known if diastolic dysfunction has an impact on prognosis of these patients. Methods: Retrospective data was obtained for adults (>18 years) that underwent hematopoietic stem cell transplantation over a period of 1991 - 2012 (22 years). Demographic, echocardiogrpahic and mortality data were obtained. Cox proportional hazard model was used to analyze diastolic dysfunction as a predictor of mortality, graft versus host disease (GVHD), systolic heart failure (ejection fraction ≤50%) and sepsis. Diastolic dysfunction was defined according to American Society of Echocardiography guidelines. Results: Out of 770 patients (mean age 48.9±13.4, women 47.7%) had 91 (11.8%) patients with pre - transplant diastolic dysfunction. Patients with diastolic dysfunction were more likely to be older, hypertensive, ≥2 comorbidities and suffer from solid organ malignancy (p <0.05). Diastolic dysfunction was associated with GVHD (HR 2.69; 95% CI 1.42 - 5.10, p =0.002), post - transplant systolic heart failure (HR 3.25;95% CI 1.68 - 6.29, p=0.0001), 30 - day rehospitalizations (HR 1.81;95% CI 1.22 - 2.45, p = 0.003) and mortality (HR 2.62;95% CI 2.11 - 3.25, p = 0.0001). However, intensive care unit treatment, length of stay and sepsis were not associated with pre - transplant diastolic dysfunction. Conclusion: Pre - transplant diastolic dysfunction in this group of patients was associated with worse prognosis after transplantation. These findings might help guide therapies and early treatment/management of these patients, so that these complications might be prevented. <!--Copyright (c) 2006 Microsoft Corporation. All rights reserved.-->