title: Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample.
abstract: Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multicenter study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplant Network was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (February 2002 to December 2012). MACE was defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism, and/or stroke. Of 32 810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days, respectively. Recipients with MACE were older and more likely to have a history of nonalcoholic steatohepatitis (NASH), alcoholic cirrhosis, MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age >65 years (incidence rate ratio [IRR] 2.8, 95% confidence interval [95% CI] 1.8-4.4), alcoholic cirrhosis (IRR 1.6, 95% CI 1.2-2.2), NASH (IRR 1.6, 95% CI 1.1-2.4), pre-LT creatinine (IRR 1.1, 95% CI 1.04-1.2), baseline AF (IRR 6.9, 95% CI 5.0-9.6) and stroke (IRR 6.3, 95% CI 1.6-25.4) were independently associated with MACE. MACE was associated with lower 1-year survival after LT (79% vs. 88%, p < 0.0001). In a national database, MACE occurred in 11% of LT recipients and had a negative impact on survival. Pre-LT AF and stroke substantially increase the risk of MACE, highlighting potentially high-risk LT candidates.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.|Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: L B
authors.initials: LB
authors.lastname: VanWagner
authors.affiliation: Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: M
authors.initials: M
authors.lastname: Serper
authors.affiliation: Center for Heathcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: R
authors.initials: R
authors.lastname: Kang
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.|Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: J
authors.initials: J
authors.lastname: Levitsky
authors.affiliation: University HealthSystem Consortium, Chicago, IL.|Rush University Health Systems Management Department, Chicago, IL.
authors.forename: S
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: M
authors.identifier: 0000-0001-9333-463X
authors.initials: M
authors.lastname: Abecassis
authors.affiliation: Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: A
authors.initials: A
authors.lastname: Skaro
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.|Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: D M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006333:Heart Failure / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Organ Procurement and Transplantation Network (OPTN); cardiovascular disease; clinical research/practice; comorbidities; complication: medical/metabolic; health services and outcomes research; liver transplantation/hepatology; risk assessment/risk stratification