P004: HEART FAILURE AFTER LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE
Waseem Alfahel, Bhavna Singh, Martine Lindsay, Mahmoud Sleem, Fouad G Souki, Nicolau-Raducu Ramona; Jackson Memorial Hospital
Background: Patients undergoing orthotopic liver transplantation (OLT) are at high risk for cardiovascular events perioperatively. Among the many cardiopulmonary complications, postoperative heart failure is a distinct clinical entity with high mortality and paucity of knowledge regarding its characteristics. We describe the incidence, characteristics, and outcome of postoperative heart failure in OLT patients at our institution.
Methods: Following institutional review board approval, adult patients undergoing OLT at University of Miami/Jackson Memorial Hospital from January 2016 to December 2018 were included in the study (287 patients). Data was obtained by retrospective review of electronic medical records. The primary outcome was the development of new onset LV and/or RV heart failure within 1-year post-transplant. Cardiac function was assessed pre and postoperatively by echocardiography. Demographics, time of onset, etiology, and potential risk factors were obtained from a comprehensive review of medical record.
Results: Overall incidence of post-transplant systolic HF was 6% (17/287) with a median diagnostic time interval 12 (3-68) days. The lowest median LVEF was 32 (18-35) %. The etiology of post-transplant systolic HF was ischemic in 2% (6/287) and nonischemic in 4% (11/287) (Figure 1). Post-transplant de-novo ischemic systolic HF was reported in <1% (2/248) of those who had normal function and stress test pre-transplant. Mortality among those with postoperative HF was 6/17 (35%). The 1-year survival rate was significantly higher in patients who didn’t develop cardiac dysfunction (96%) compared to those who did (65%).
Pre-transplant reduced LV systolic dysfunction (EF<55%) was reported in 2% (5/287) with a median LVEF of 45 (45-52) % (Figure 1). Etiology of decreased EF pre-transplant: ischemic (3) and non-ischemic (2). Among the patients with pre-transplant decreased EF, post-transplant worsening LV function was recorded in 60% (3/5). Kaplan Meier 1-year survival did not report a statistically significant difference between patients with and without pre-transplant cardiomyopathy (94% and 100%), nor was there a difference in post-transplant ICU and hospital stay.
Four pre-transplant risk factors were statistically associated with post-transplant systolic HF: type of organ transplanted (liver vs. liver-kidney), history of TIPS, history of CAD, and mechanical ventilation prior to transplantation.
When compared with non-HF group, a statistical association was found between HF and TIPS (OR 5.3, 95%CI 1.821-15.685), history of CAD (OR 4, 95%CI 1.404-11.720), pre-transplant CMP (OR 28.7, 95%CI 4.434-185.960), and pre-transplant intubation (OR 4.6, 95%CI 1.347-15.565).
Conclusion: Post-transplant cardiomyopathy is more nonischemic than ischemic. Patients with pretransplant cardiomyopathy are more likely to drop their EF postoperatively. Combined liver-kidney transplant, TIPS, CAD, and pretransplant mechanical ventilation are risk factors for post-transplant heart failure. Post-transplant cardiomyopathy negatively impacts the 1-year survival rate. Patients with post-operative cardiomyopathy should be followed up carefully.