P005: RISK FACTORS ASSOCIATED WITH DEVELOPMENT OF NEW ONSET HEART FAILURE POST-TRANSPLANT: SINGLE CENTER, RETROSPECTIVE STUDY
Massud Turbay, MD; Fouad Souki, MD; Yehuda Raveh, MD; Joshua Livingstone; Vadim Shatz, MD; Ahmed Zaghw, MD; Ramona Nicolau-Raducu, MD; Jackson Memorial Hospital
Introduction: The purpose of our study is to identify the incidence, potential risk factors, characteristics, and outcome of new-onset heart failure (HF) after liver transplantation in patients with preserved left ventricular ejection fraction (LVEF ≥ 55%) pre-transplant.
Method: After excluding two patients who died intraoperatively and seven patients with preexisting cardiomyopathy (EF<55%), 528 patients were included in the study. The primary outcome was the development of new-onset systolic HF post-transplant defined by echocardiographic evidence of falling left and/or right ventricular function within 1st year. We grouped post-transplant HF into ischemic and non-ischemic groups.
Results: Within 1st year of transplant, new-onset HF occurred in 6% (31/528) of the patients. Ischemic HF accounted for 1% (7/528) while non-ischemic HF accounted for 5% (24/528) of the cases. Ischemic HF comprised 23% (7/31) and non-ischemic HF comprised 77% (24/31) of post-transplant HF cases, see Figure 1. Three pre-transplant risk factors were statistically associated with post-transplant new-onset HF: a prolonged QTc ≥490 ms, presence of diastolic dysfunction, and a body mass index < 24 kg/m2. Two intraoperative risk factors were statistically associated with post-transplant: Lower baseline hemoglobin at the time of transplant and intraoperative administration of vasopressors such as epi/nor-epinephrine. Under logistic regression, the whole model was statistically significant (χ2=33, P<0.0001). A C-index of 0.79 was calculated for these risk factors. Non-ischemic HF and ischemic HF had significantly lower 1-year survival than patients without HF, 63% and 71% versus 94%, respectively (Log-Rank P<0.0001). Biventricular LV/RV and isolated RV failure had lower survival of 50% than isolated LV failure 71% when compared with the group without HF of 94% (Log-Rank P<0.0001).
Conclusion: Patients undergoing liver transplantation are at high risk for postoperative cardiovascular events such as: new-onset heart failure despite thorough preoperative cardiac evaluation.