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Title: Prediction of Perioperative Cardiovascular Events in Liver Transplantation.
Austin Authors: Koshy, Anoop N ;Farouque, Omar ;Cailes, Benjamin ;Ko, Jefferson ;Han, Hui-Chen ;Weinberg, Laurence ;Testro, Adam G ;Teh, Andrew W ;Lim, Han S ;Gow, Paul J 
Affiliation: Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Parkville, Victoria, Australia
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 11-May-2020 2020-05-11
Publication information: Transplantation 2020; online first: 11 May
Abstract: Hepatorenal syndrome (HRS) is a serious complication of liver cirrhosis with poor survival in the absence of liver transplantation (LT). HRS represents a state of profound circulatory and cardiac dysfunction. Whether it increases risk of perioperative major adverse cardiovascular events (MACE) following LT remains unclear. We performed a retrospective cohort study of 560 consecutive patients undergoing cardiac workup for LT of whom 319 proceeded to LT. All patients underwent standardized assessment including dobutamine stress echocardiography. HRS was defined according to International Club of Ascites criteria. Primary outcome of 30-day MACE occurred in 74(23.2%) patients. A significantly higher proportion of patients with HRS experienced MACE(31(41.9%) vs 54(22.0%); p=0.001). After adjusting for age, MELD score, cardiovascular risk index, history of CAD and a positive stress test, HRS remained an independent predictor for MACE (odds ratio (OR)2.44; 95%CI 1.13-5.78). Other independent predictors included poor functional status(OR 3.38; 95%CI 1.41-8.13), pulmonary hypertension(OR 3.26; 95%CI 1.17-5.56) and beta-blocker use(OR 2.56; 95%CI 1.10-6.48). Occurrence of perioperative MACE was associated with a trend towards poor age-adjusted survival over 3.6-year follow-up (hazard ratio 2.0; 95%CI 0.98-4.10,p=0.057). HRS, beta-blocker use, pulmonary hypertension and poor functional status were all associated with over a 2-fold higher risk of MACE following LT. Whether inclusion of these variables in routine preoperative assessment can facilitate cardiac risk stratification warrants further study.
DOI: 10.1097/TP.0000000000003306
ORCID: 0000-0002-8741-8631
PubMed URL: 32413014
Type: Journal Article
Appears in Collections:Journal articles

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