Cardiovascular Mortality following Liver Transplantation: Predictors and Temporal Trends over 30 years.

Abstract

There has been significant evolution in operative and post-transplant therapies following liver transplantation (LT). We sought to study their impact on cardiovascular mortality, particularly in the longer-term. A retrospective cohort study was conducted of all adult LTs in Australia and New Zealand across three 11-year eras from 1985 to assess prevalence, modes and predictors of early (≤30-day) and late (>30-day) cardiovascular mortality. A total of 4,265 patients were followed-up for 37,409 person-years. Overall, 1,328 patients died, and cardiovascular mortality accounted for 228 (17.2%) deaths. Both early and late cardiovascular mortality fell significantly across the eras (p < 0.001). However, cardiovascular aetiologies were consistently the leading cause of early mortality and accounted for ∼40% of early deaths in the contemporary era. Cardiovascular deaths occurred significantly later than non-cardiac aetiologies (8.8 vs 5.2 years, p < 0.001). On multivariable Cox-regression, coronary artery disease (HR 4.6,95%CI 1.2-21.6, p = 0.04) and era of transplantation (HR 0.44; 95%CI 0.28-0.70, p = 0.01) were predictors of early cardiovascular mortality while advancing age (HR 1.05, 95%CI 1.02-1.10, p = 0.005) was an independent predictors of late cardiovascular mortality. Most common modes of cardiovascular death were cardiac arrest, cerebrovascular events and myocardial infarction. Despite reductions in cardiovascular mortality post-LT over 30-years, they still account for a substantial proportion of early and late deaths. The late occurrence of cardiovascular deaths highlights the importance of longitudinal follow-up to study the efficacy of targeted risk-reduction strategies in this unique patient population.