Prediction of cardiac complications after liver transplantation.
BACKGROUND
Orthotopic liver transplantation (OLT) stresses the cardiovascular system, and cardiac complications after OLT are common.


METHODS
Hundred ninety-seven patients (>or=40 years) who had OLT from 2002 to 2007 were reviewed to identify predictors of cardiac complications within 6 months after transplantation.


RESULTS
Median age was 56 years (40-75 years); 69% men. Reasons for OLT were hepatitis C virus (HCV) 45.5%, alcohol 22%, hepatocellular carcinoma (HCC) 8%, primary biliary cirrhosis 10%, and others 14.5%. Eighty-two patients suffered one or more cardiac complications within 6 months after OLT (pulmonary edema=61 [overt heart failure=7], arrhythmia=13, pulmonary hypertension=7, pericardial effusion=2, and right atrial thrombus=1). Cardiac causes were the leading cause of death (n=5; 23.8% of all mortality). By multivariate analysis, after adjusting for age and sex, independent predictors were adverse intraoperative cardiovascular events (adjusted odds ratio; 95% confidence interval: 5.89, 1.82-19.14), history of cardiac disease (2.42, 0.89-6.6), and i-MELD (integrated model for end-stage liver disease) score (1.08, 1.02-1.14), whereas adverse intraoperative cardiovascular events (5.73, 1.96-16.78) and i-MELD (1.07, 1.01-1.13) predicted pulmonary edema. None of the following variables predicted complications: age, sex, OLT indication, body mass index, blood pressure, alcohol and smoking history, pre-OLT investigations (chest X-ray, electrocardiogram, echocardiography, coronary angiography, pulmonary arterial pressure, and 2-methoxy isobutyl isonitrile scan), immunosuppressive treatment, or intraoperative variables (transfusion amount, cadaveric vs. living graft or cold ischemia and rewarming times).


CONCLUSIONS
Cardiac complications after OLT are common and were the leading cause of death after surgery. Adverse intraoperative cardiovascular events, previous cardiac disease, and advanced liver disease as quantified by i-MELD score predicted postoperative cardiac complications.
Fouad
Tamer R
TR
Liver Unit, University of Calgary, Calgary, AB, Canada.
Abdel-Razek
Wael M
WM
Burak
Kelly W
KW
Bain
Vincent G
VG
Lee
Samuel S
SS
D000328:Adult; D000368:Aged; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012720:Severity of Illness Index