Risk Factors and Cardiovascular Events in Orthotopic Liver Transplantation.

Background and aims: Patients undergoing liver transplantation often have significant cardiovascular risk factors and may experience cardiac-related morbidity and mortality. The aim of this study was to assess the frequency of cardiovascular risk factors and outcomes in this population, and to identify factors predictive of post-transplant cardiac morbidity and mortality.

Methods: We studied 261 patients who underwent liver transplantation at a single Veterans' Affairs Medical center between 1997 and 2015 to evaluate new cardiovascular events post-transplantation.

Results: The cohort consisted of 261 patients (253 men and 8 women) with a mean age of 58.3 (± 6.5 years), mean model for end-stage liver disease score of 18.0 (±7.2), and mean Framingham risk score of 8.1 (± 4.9). After a median follow-up of 82 months a total of 75 (28.7%) patients died, with 13 deaths (17.3%) attributed to a primary cardiovascular event and 9 (12%) deaths due to a coronary-specific event. Coronary events and/ or the need for revascularization post-transplant occurred in 24 (9.2%) patients. The strongest pre-transplant predictors of mortality were age (p=0.01), Framingham risk score (p=0.01), preexisting coronary artery disease (p=0.01), and preexisting dyslipidemia (p=0.01). The strongest post-transplant predictors of mortality were new-onset hypertension (p=0.01) and new-onset diabetes mellitus (p=0.03) post-transplant.

Conclusions: In this cohort of veterans, coronary artery disease was significantly associated with mortality in the post liver transplantation population; however, the majority of deaths after transplant were attributable to other causes.