PREDICTION OF CARDIAC COMPLICATIONS AFTER LIVER TRANSPLANTATION

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PREDICTION OF CARDIAC COMPLICATIONS AFTER LIVER TRANSPLANTATION

TR Fouad¹, A Aziz M Shaheen¹, KW Burak¹, VG Bain², SS Lee¹
¹Liver Unit, University of Calgary, Calgary; ²Dept of Medicine, Division of Gastroenterology, University of Alberta, Edmonton

AIM: to identify predictors of cardiac complications after OLT.
METHODS: retrospective review of patients who had OLT at University of Alberta Hospital from Oct 2002 to Feb 2007, excluding those <40 years old, and followed up for 6 months after OLT.
RESULTS: 200 out of 380 OLT patients (> 40 ys) at time of transplantation were studied. Median age was 56 yr [IQR: 51-61], (69%) were males. Reasons for OLT were alcohol 36%, HCV 45%, HCC 20%, PBC 10%, others 29%. Eighty two patients suffered one or more cardiac complications after OLT (pulmonary edema=61[moderate or severe=14, early “within one week” =58], arrhythmia=13, overt heart failure=7, pulmonary hypertension=7, cardiac death=6, pericardial effusion=2 and right atrial thrombus=1). By univariate analysis, previous history of cardiac disease (p=0.016) & diastolic dysfunction (p=0.043) were significant for all complications while EDT, deceleration time of E velocity, (p=0.048) was significant for early pulmonary edema and EF, ejection fraction (p=0.043) for arrhythmia;. By multivariate analysis, after adjusting for age and sex, independent predictors of all complications were previous history of cardiac complications (aOR 95% CI:3.65,1.36-9.77) & diastolic dysfunction (0.37,0.15-0.93) while predictor for early edema was EDT (3.53,2.28-5.48) and predictor for arrhythmia was EF (1.17,1.00-1.37). Non of the following was significant: age, sex, cause of OLT, blood pressure, history of smoking, diabetes, alcohol consumption, PROCAM (Prospective Cardiovascular Münster study) risk score, pre-OLT investigations: chest X-ray, ECG, left atrial enlargement, any chamber enlargement, coronary angiography, pulmonary arterial pressure, MIBI scan.
CONCLUSIONS: A significant proportion of patients (41%) had cardiac complications within the first 6 months after OLT; 90% (74/82) had arrhythmia or pulmonary edema. Previous cardiac disease and diastolic dysfunction could predict the occurrence of cardiac complications after OLT. Both EDT and EF can predict early edema and arrhythmia respectively. These results should be validated by larger prospective studies.

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