Cardiovascular risk and events after liver transplantation. Experiences from 313 consecutive transplants with a follow‐up of 20 years

Schoening, Wenzel; Neidel, Nadja; Buescher, Niklas; Ανδρέου, Ανδρέας; Pascher, Andreas; Seehofer, Daniel; Bahra, Marcus; Schmitz, Volker; Pratschke, Johann; Puhl, Gero

doi:10.1111/ctr.12520

Cited by 4 publications

(6 citation statements)

References 25 publications

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“…Numerous studies have demonstrated significant CV morbidity and mortality after liver transplantation . However, these outcomes vary across reports.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations for Cardiovascular Disease After Liver Transplantation in the United States†

Khurmi¹,

Chang²,

Steidley³

et al. 2018

Liver Transpl

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Cardiovascular disease (CVD) is a leading cause of post-liver transplant death, and variable care patterns may affect outcomes. We aimed to describe epidemiology and outcomes of inpatient CVD care across US hospitals. Using a merged data set from the 2002-2011 Nationwide Inpatient Sample and the American Hospital Association Annual Survey, we evaluated liver transplant patients admitted primarily with myocardial infarction (MI), stroke (cerebrovascular accident [CVA]), congestive heart failure (CHF), dysrhythmias, cardiac arrest (CA), or malignant hypertension. Patient-level data include demographics, Charlson comorbidity index, and CVD diagnoses. Facility-level variables included ownership status, payer-mix, hospital resources, teaching status, and physician/nursing-to-bed ratios. We used generalized estimating equations to evaluate patient- and hospital-level factors associated with mortality. There were 4763 hospitalizations that occurred in 153 facilities (transplant hospitals, n = 80). CVD hospitalizations increased overall by 115% over the decade (P < 0.01). CVA and MI declined over time (both P < 0.05), but CHF and dysrhythmia grew significantly (both P < 0.03); a total of 19% of hospitalizations were for multiple CVD diagnoses. Transplant hospitals had lower comorbidity patients (P < 0.001) and greater resource intensity including presence of cardiac intensive care unit, interventional radiology, operating rooms, teaching status, and nursing density (all P < 0.01). Transplant and nontransplant hospitals had similar unadjusted mortality (overall, 3.9%, P = 0.55; by diagnosis, all P > 0.07). Transplant hospitals had significantly longer overall length of stay, higher total costs, and more high-cost hospitalizations (all P < 0.05). After risk adjustment, transplant hospitals were associated with higher mortality and high-cost hospitalizations. In conclusion, CVD after liver transplant is evolving and responsible for growing rates of inpatient care. Transplant hospitals are associated with poor outcomes, even after risk adjustment for patient and hospital characteristics, which may be attributable to selective referral of certain patient phenotypes but could also be related to differences in quality of care. Further study is warranted.

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“…Numerous studies have demonstrated significant CV morbidity and mortality after liver transplantation . However, these outcomes vary across reports.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations for Cardiovascular Disease After Liver Transplantation in the United States†

Khurmi¹,

Chang²,

Steidley³

et al. 2018

Liver Transpl

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“…A longitudinal single‐institution study was performed to evaluate the risk and the incidence of CBVE over 20 years of follow‐up after LT. The cohort has already been described in detail in two other publications of our group …”

Section: Methodsmentioning

confidence: 99%

“…At primary LT, mean patient age was 45±11 years. Indications for primary transplants are presented in Table , but may also be reviewed in the abovementioned papers . Virus‐related cirrhosis (29.4%), alcoholic cirrhosis (16.0%), and cholestatic diseases (16.7%) were the most common indications for primary LT.…”

Section: Methodsmentioning

confidence: 99%

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Cerebrovascular events in 20 years of follow‐up after liver transplantation: an underestimated issue?

Schoening

Buescher

Neidel

et al. 2016

Clinical Transplantation

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“…(See Table 3, Ref. [1,55,78]) for comparison of CAR-OLT and PROCAM). They included 8 variables: smoking, LDL cholesterol, age, HDL cholesterol, family history of premature myocardial infarction, systolic blood pressure, triglycerides, and diabetes mellitus.…”

Section: Prediction Of Cardiovascular Events After Liver Transplantationmentioning

confidence: 99%

Cardiovascular events after liver transplantation: MACE hurts

Altieri¹,

Liu²,

Lee³

2022

Rev. Cardiovasc. Med.

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The curative therapy for patients with end-stage liver disease is liver transplantation. However, liver transplantation challenges the cardiovascular system, and is associated with major adverse cardiovascular events (MACE). Immediately after implantation of the liver graft, changes in cardiac preload and afterload increase the cardiac workload. Longer-term postoperatively, a more sedentary lifestyle and enhanced appetite increase obesity and body mass index. Immunosuppressants may also affect the cardiovascular system. All these factors that liver recipients encounter impact the function of the cardiovascular system. Cardiac events are the third-leading cause of death in liver recipients. This review describes the pertinent factors that predispose to development of MACE after liver transplantation, and how to predict these cardiovascular events in the post-transplant period. We review the roles of metabolic syndrome, renal dysfunction, non-alcoholic fatty liver disease, diagnostic tests such as imaging and biomarkers, and parameters such as systolic and diastolic dysfunction, and QT interval prolongation in cardiovascular events. We summarize the current literature on scoring systems to predict cardiovascular events.

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Cardiovascular risk and events after liver transplantation. Experiences from 313 consecutive transplants with a follow‐up of 20 years

Cited by 4 publications

References 25 publications

Hospitalizations for Cardiovascular Disease After Liver Transplantation in the United States†

Hospitalizations for Cardiovascular Disease After Liver Transplantation in the United States†

Cerebrovascular events in 20 years of follow‐up after liver transplantation: an underestimated issue?

Cardiovascular events after liver transplantation: MACE hurts

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