title: Pre-transplant renal impairment predicts posttransplant cardiac events in patients with liver cirrhosis.
abstract: BACKGROUND
  Cardiovascular disease and renal impairment are common in cirrhotic transplant candidates. We aimed to investigate potential association between pretransplant renal function impairment and cardiac events after liver transplantation.
  
  
  METHODS
  Adult cirrhotic patients undergoing first-time liver transplantation between 1999 and 2007 in a single institution with available glomerular filtration rate (GFR), assessed by Cr-EDTA clearance at pre-transplant evaluation, were retrospectively enrolled (n=202). Impaired renal function was defined as GFR less than 60 mL/min/1.73 sqm. Pretransplant QT-time corrected by heart rate (QTc) and left-ventricular dysfunction was also registered. Mortality and cardiac events were analyzed, until death or last follow-up (end 2009).
  
  
  RESULTS
  Renal impairment was present in 24% (48/202). Cardiac events occurred in 28% (56/202) after transplantation, mean follow-up time of 3.8 years (2.2). Events were more common in patients with renal impairment compared with those without (48% versus 21%, P<0.001). In Cox regression analysis, pretransplant renal impairment was found to be an independent predictor of posttransplant cardiac events (HR 2.19, 95% CI 1.25-3.85) and reduced cardiac event-free survival (HR 2.27, 95% CI 1.31-3.94). Prolonged QTc interval was an independent predictor of posttransplant cardiac events in the subgroup with pretransplant electrocardiogram and echocardiogram (n=166 and n=112, HR 4.75, 95% CI 2.07-10.9); however, left-ventricular diastolic dysfunction was not (P>0.05). A pretransplant score comprising renal impairment, prolonged QTc interval, and age older than 52 was developed for prediction of 3- and 12-month cardiac events (c-statistic 0.73 and 0.75, respectively).
  
  
  CONCLUSIONS
  Pretransplant renal impairment is a predictor of cardiac event after liver transplantation together with prolonged QTc interval.
authors.affiliation: 1 Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2 Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland. 3 Transplant institute, Sahlgrenska University Hospital, Gothenburg, Sweden. 4 Department of Gastroenterology, Skåne University Hospital, Lund, Sweden. 5 Address correspondence to: Axel Josefsson, M.D., Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Göteborg, Sweden.
authors.forename: Axel
authors.initials: A
authors.lastname: Josefsson
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
authors.forename: Maria
authors.initials: M
authors.lastname: Castedal
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006339:Heart Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016277:Ventricular Function, Left; D055815:Young Adult