Background: Cardiac events (CVE) remain a significant source of morbidity in the early post-transplant(post-tx) period despite extensive evaluation prior to liver transplant(LT). It is important to identify less traditional risk factors for early post-tx CVE that may be amenable to modification.We evaluated predictors of early post-tx CVE and all-cause mortality in LT patients.

Methods: We performed a single-center, retrospective analysis of adults undergoing primary LT from Jan 2002 to April 2017. We analyzed the effect of several pre-transplant factors on the time to first post-tx CVE up to 6-months post-tx using Cox proportional hazards regression. CVE included any of the following: myocardial infarction (MI), heart failure (HF), arrhythmia, cardiac arrest, cerebrovascular accident (CVA) and peripheral vascular disease (PVD). Patients were censored if they had graft failure or death<6 months post-tx. We also examined all-cause patient mortality with censoring at last patient follow-up visit.

Results: 571 patients underwent LT during the study period. 176(30.8%) patients were female.154(27%) patients received a LT for alcoholic liver disease. 80(14%) patients received a simultaneous liver-kidney transplant. First post-tx CVE occurred in 135 patients over the study period including 10 MI, 15 cardiac arrest, 10 HF and 128 arrhythmia.12 patients had multiple events on the day of their first CVE. Patients with a post-tx CVE were older (57 vs 53.8 years old,p=0.001); had higher serum creatinine at transplant (2.5 vs 2.03,p=0.021); had a higher BMI (29.3 vs 28.0,p=0.042) and prior history of CVE (34.1% vs 21.6%,p=0.005). Increasing age (HR 1.04,95% CI 1.02-1.07,p<0.001); BMI (HR 1.04,95% CI 1.00-1.07,p=0.026) and serum sodium (HR 1.04,95% CI 1.00-1.08,p=0.042) were predictive of early post-tx CVE. Increased BMI>28 (HR 1.12,95% CI 1.02-1.22,p=0.017) was predictive of mortality whereas history of autoimmune liver disease (HR 0.43,95% CI 0.2-0.95,p=0.037) was protective.

Conclusion: Early CVE remain prevalent in LT recipients despite extensive pre-transplant evaluation. Obesity is a unique and potentially modifiable pre-transplant predictor of early CVE. Interventions focused on reducing BMI prior to transplant may reduce early CVE in LT recipients.

CITATION INFORMATION: Mahgoub A., Jackson S., Lake J., Lim N. Increased BMI is a Predictor of Early Post-Transplant Cardiac Events and Mortality Am J Transplant. 2017;17 (suppl 3).

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