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Title: Cardiovascular Mortality following Liver Transplantation: Predictors and Temporal Trends over 30 years.
Austin Authors: Koshy, Anoop N ;Gow, Paul J ;Han, Hui-Chen ;Teh, Andrew W ;Jones, Robert M ;Testro, Adam G ;Lim, Han S ;McCaughan, Geoffrey;Jeffrey, Gary P;Crawford, Michael;Macdonald, Graeme;Fawcett, Jonathan;Wigg, Alan;Chen, John W C;Gane, Edward J;Munn, Stephen R;Clark, David J ;Yudi, Matias B ;Farouque, Omar 
Affiliation: School of Medicine, The University of Queensland, Brisbane, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Sir Charles Gardiner Hospital, Perth, Australia
School of Medicine, University of Western Australia, Nedlands, Australia
Princess Alexandra Hospital, Brisbane, Australia
Flinders Medical Centre, Adelaide, Australia
Royal Prince Alfred Hospital, Sydney, Australia
University of Sydney, Sydney, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Parkville, Victoria, Australia
Auckland City Hospital, New Zealand
Issue Date: 1-Oct-2020 2020-02-03
Publication information: European Heart Journal. Quality of Care & Clinical Outcomes 2020; 6(4): 243-253
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.
DOI: 10.1093/ehjqcco/qcaa009
ORCID: 0000-0002-8741-8631
PubMed URL: 32011663
Type: Journal Article
Subjects: cardiac death
cardiovascular mortality
cirrhotic cardiomyopathy
liver transplantation
Appears in Collections:Journal articles

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