*Purpose: Assess the prevalence and characteristics of patients with pre-transplant left ventricular diastolic dysfunction (LVDD) and its potential impact on post-transplant morbidity and mortality.

*Methods: Retrospective study of 80 consecutive cirrhotic patients undergoing liver transplantation (LT) from 1/1/2021 to 10/31/2021 at the University of Maryland Medical Center. Data were collected on pre-transplant demographics, cardiovascular risk factors, etiology of liver disease, Model for End-Stage Liver Disease score (MELD-Na), Child Pugh score (CP), and presence of coronary artery disease (CAD); and post-transplant hospital and intensive care unit (ICU) stay, readmission rate, new major cardiovascular event (MACE), and mortality rate. Left ventricular diastolic function was assessed by transthoracic echocardiogram using the American Society of Echocardiography 2016 guidelines.

*Results: Mean age at LT was 54.2 years (range 24-57) and mean MELD-Na 25.3 (range, 6-40); 40% were women. 58.8%, 25%, 12.5%, and 3.8% had alcoholic liver disease, nonalcoholic fatty liver disease, viral hepatitis, or other etiologies, respectively; 21.3% had hepatocellular carcinoma; and 12.5%, 20%, and 67.5% had CP of A, B, and C, respectively. Hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD), and obesity were present in 62.5%, 30%, 26.3, and 40%, respectively; and 61.3% had smoking history (81.6% of which former smoker). All patients had normal left ventricular ejection fraction and six had obstructive CAD requiring intervention pre-transplant.

Patients were divided into three groups according to left ventricular diastolic function, 55 (68.8%), 10 (12.5%), and 15 (18.8%) had normal, indeterminate, or abnormal diastolic function, respectively. Mean follow up time in days was 166.9 days post-transplantation (range, 0-320), 4 patients (5%) died, 7 (8.8%) developed MACE, and 41 (51.3%) were readmitted at least once. There were no significant differences (p≥0.05) among the three groups with regards to prevalence of HTN, DM, HLD, obesity, smoking history, or obstructive CAD; or post-transplant incident MACE, duration of hospital or ICU stay, readmission rate, or mortality rate. However, patients with normal left ventricular diastolic function had longer mean survival time in days compared to patients with indeterminate and abnormal diastolic function (184.0 vs. 106.9 and 144.2 days, respectively, p=0.02).

*Conclusions: The prevalence of LVD dysfunction in cirrhotic patients undergoing LT was 18.8%. Although larger sample size and longer follow-up are required to obtain more conclusive results, our study suggests that LVD dysfunction may be associated with lower mean post liver transplantation survival time.

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