Background

Heart failure (HF) after liver transplantation (LT) is poorly understood. Small, retrospective studies have analyzed new onset systolic HF after LT, but rates are variable and predictors were not systematically evaluated. Our study aims to evaluate pre-transplant demographic, clinical, biochemical and echocardiographic parameters as predictors of post LT HF.

Methods

Data were collected retrospectively for consecutive LT recipients between January 2000 and December 2010. Demographic and mortality data were obtained from the social security index. Cardiac risk factors, etiology of transplant, QT interval, pre-transplant echocardiographic variables and laboratory data were collected by chart review. The primary outcome was post-transplant heart failure – Systolic (EF<50%), Diastolic or mixed. Etiology of heart failure and mortality was also evaluated. Pre-transplant variables were evaluated as predictors of post LT HF using a Cox proportional hazard model.

Results

A total of 970 LT recipients were followed for 5.3 ± 3.4 years. Of these, 98 (10.1%) developed heart failure in the post-transplant period, with systolic in 67 (6.9%), diastolic in 24 (2.5%) and mixed systolic/diastolic HF in 7 (0.7%).

Pre-transplant mean arterial blood pressure <60 mm Hg, diastolic dysfunction grade 3, prolonged QT, pulmonary artery systolic artery pressure, E/e’ ratio and E/A ratio (Table 1) were significantly associated with post-transplant HF after adjusting for age, gender, race, pre-transplant EF, cardiac risk factors, drug use, MELD score and indication for transplant.

Post-transplant heart failure was also associated with increased all- cause mortality (HR 2.3, 95% CI 1.7-2.9, p=0.0001).

Traditional cardiovascular risk factors, pre-transplant systolic dysfunction (EF<50%), BNP, peak troponin, MELD score and sodium levels were not significantly associated with post-transplant heart failure.

Conclusion

Pre-transplant echocardiographic features, QT prolongation and mean BP are predictors of post-transplant cardiac dysfunction, which is associated with increased mortality.

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