Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis

Abstract

Aims and Objectives: Takotsubo cardiomyopathy (TCMP) is an acquired cardiomyopathy associated with physical, emotional, and surgical stress. Current literature on TCMP in liver transplant recipients (LTRs) is limited to case reports and case series. Methods: The Nationwide Readmission Database was utilized to identify all adults with an index admission for LT between 2010 and 2014 who developed TCMP. The prevalence of TCMP at the LT admission or readmission within the calendar year was examined. Predictors of development and health-care utilization of patients with and without TCMP in LTR were compared. Multivariable regression analysis was performed. Results: The prevalence of TCMP in LTRs was found to be 0.5% (141/28,067). Most of these patients developed early TCMP on the index admission for LT (n = 115; 82%). Older (57.5 ± 1.3 vs. 55.1 ± 0.3 years, P < 0.001) females (adjusted odds ratio [aOR]: 2.27; confidence interval [CI]: 1.20–4.27; P = 0.01) with ≥4 Elixhauser comorbidity (aOR: 2.36; CI: 1.15–4.83; P = 0.02) were predisposed to develop TCMP in LTRs. LT at a medium-sized center (aOR: 0.17; CI: 0.03–0.88) has a protective effect on the development of TCMP. Increased health-care utilization in the form of mechanical ventilation, hemodialysis, vasopressors, and intra-aortic balloon pumps is observed in patients with TCMP. This resulted in increased length of stay and cost in patients with TCMP. Moreover, increased mortality was seen in patients who developed TCMP within the same calendar year. Conclusion: This is the first report showing the prevalence of TCMP in LTRs to be 0.5%. Older females with increased comorbidity are predisposed to TCMP. Patients who developed TCMP necessitate a higher acuity of medical care and cause an increased health-care burden and ultimately experience an increase in mortality.

Cardiomyopathy After Solid Organ Transplantation: A Scoping Review

“…Due to the rarity of this condition and reported cases, no data are available on the prevalence. However, TTS studies showed that TTS occurred in 0.3–1.7% in liver transplant recipient 5 . For the cases following OLTs, most cases occurred early post-surgery 11 , the same is for the kidney transplant cases 3 , 8 , 12 – 14 .…”

“…A substantial portion of the perioperative cardiac complications can be attributed to TTS, which is commonly triggered by surgery 4 , 5 . According to studies, the incidence of perioperative TTS will increase in proportion to the severity of the surgical trauma, the duration of the operation, and the degree of apparent sympathetic activation.…”

“…Solid organ transplant (SOT) is at the top of the conditions in which physical and emotional stress is at the highest level, and an increasing number of articles have reported on TTC occurring post-SOT 5 , 7 . Most publications concern orthotopic liver transplant (OLT) patients 5 , 8 , 9 , although kidney, heart and lung transplant patients are also being discussed 7 , 8 , 10 .…”

“…Solid organ transplant (SOT) is at the top of the conditions in which physical and emotional stress is at the highest level, and an increasing number of articles have reported on TTC occurring post-SOT 5 , 7 . Most publications concern orthotopic liver transplant (OLT) patients 5 , 8 , 9 , although kidney, heart and lung transplant patients are also being discussed 7 , 8 , 10 . The higher occurrence of TTS following liver transplants might be attributed to the immense stress on the cardiovascular system from the surgery itself and the impaired stress response in liver transplant candidates due to the inflammation associated with hepatic cirrhosis 9 .…”

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“…[10] Mumtaz K, et al discussed a USA-based national analysis of the predisposing factors and healthcare utilization in liver transplant recipients with Takotsubo cardiomyopathy. [11] Finally, Lamouri et al gave an insight into the motives and family relations of living related kidney donors in Tripoli. [12] A couple of interesting case reports on nephrocalcinosis in genetically proved dopa-responsive dystonia due to sepiapterin reductase deficiency in a Libyan girl and a direct gunshot wound to the testicular artery are presented.…”