Cardiovascular (CV) disease is a major cause of morbidity and mortality among transplant candidate and recipients of noncardiac organs. Aiming to analyze the impact of CV risk in the setting of a liver transplantation (LT) program, we evaluated the role of: 1) pre-transplant CV risk factors in predicting mortality and CV events before and after LT; 2) myocardial perfusion study (SPECT) in predicting coronary artery disease in LT patients; 3) post-transplant diabetes, hypertension, and dyslipidemia in predicting mortality and CV events.

We reviewed all consecutive patients listed for LT from December 2003 to March 2006 in our center. Baseline characteristic, preoperative risk assessment and postoperative complications were recorded. Study endpoints were: waiting list mortality, 1-year and late mortality after LT, and non-fatal major adverse cardiovascular events (MACE: arrhythmias, stroke/TIA, heart failure, thromboembolism) after LT.

Of the 322 listed patients included in the study, 201 (62%) underwent LT. The main indication for listing was hepatocellular carcinoma. Post LT survival rate at 1, 5, and 10 years was 86%, 75% and 70%, respectively. The main causes of death in list and after LT were hepatic failure and cancer. Surprisingly, none of the study patients experienced CV death either before or after LT. MACEs after transplantation occurred in 34 patients (17%): 18 (9%) patients had at least one MACE by the 1^st year after LT and 20 (10%) in the remaining follow-up. 6 (3%) patients had a myocardial infarction after LT; their preoperative SPECT was negative in 4, falsely positive in 1 (subsequent normal coronary angiogram) and not performed in 1. Diabetes, hypertension and dyslipidemia were recorded in 48, 45, and 24% respectively of the study patients. Hypertension and dyslipidemia were significantly associated with non-fatal MACE (P<0.04)

Unexpectedly, CV mortality was not clinically relevant in this series and the traditional CV risk factors did not predict mortality before or after LT, with the majority of adverse events related to the progression or relapse of liver disease. In addition, SPECT did not appear useful in detecting patients at risk for post-LT events, questioning the utility for this imaging tool in stratifying CV risk. Post-LT Hypertension and dyslipidemia were frequently detected after LT and predicted MACE, suggesting the importance of post-LT monitoring and correction of metabolic risk factor for adequate prevention.

CITATION INFORMATION: Potena L, Manfredini V, Prestinenzi P, Alabrese R, Bertuzzo V, Borgese L, Masetti M, Morelli C, Grigioni F, Pinna A. Cardiovascular Prognosis and Adverse Cardiac Events After Orthotopic Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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