title: Impact of peri-transplant heart failure & left-ventricular diastolic dysfunction on outcomes following liver transplantation.
abstract: OBJECTIVE
  Assess the prevalence of peri-transplant heart failure and its potential relation to post-transplant morbidity and mortality.
  
  
  METHODS
  A retrospective study was performed on 234 consecutive cirrhotic patients undergoing liver transplantation in a single European center from 1999 to 2007 (mean age 52, 30% women, 36% with alcoholic liver disease, 24% with viral hepatitis, 18% cholestatic liver disease). Left ventricular diastolic dysfunction was defined as E/A ratio ≤ 1. We used the Boston classification for heart failure to assess the prevalence of peri-transplant heart failure. Patients were followed up for a mean of 4 years post-transplant (0.5-9 years).
  
  
  RESULTS
  Eighteen per cent of patients demonstrated diastolic dysfunction pretransplant. During the peri-transplantation period highly possible heart failure occurred in 27%. In logistic regression analysis, heart failure was independently related to lower mean arterial blood pressure (OR 0.94, 95% CR 0.91-0.98) and prolonged corrected QT time on ECG (OR 9.10, 95% CI 3.77-21.93) pretransplant. Peri-transplant mortality amounted to 5%, and was independently related to heart failure (OR 15.11, 95% CI 1.76-129.62) and the peri-transplant need of dialysis (OR 14.18, 95% CI 1.65-121.89). Heart failure was also associated with longer stay in the intensive care unit and peri-transplant cardiac events (P < 0.05). Long-term transplant-free mortality was independently related to diastolic dysfunction at baseline (Hazard ratio 4.82, 95% CI 1.78-13.06).
  
  
  CONCLUSIONS
  Heart failure occurs in approximately a quarter of patients with cirrhosis following liver transplantation and it is an independent predictor of mortality and morbidity.
authors.affiliation: Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. axel.josefsson@vgregion.se
authors.forename: Axel
authors.initials: A
authors.lastname: Josefsson
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
authors.forename: Pari
authors.initials: P
authors.lastname: Allayhari
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
authors.forename: Maria
authors.initials: M
authors.lastname: Castedal
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D054144:Heart Failure, Diastolic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D055815:Young Adult