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Certain echocardiographic parameters increase morbidity, mortality post-transplant

Evidence of echocardiographic parameters before liver transplantation were associated with increased risk for morbidity and mortality post-transplantation.

David S. Goldberg, MD, MSCE, assistant professor of medicine and medical director of living donor liver transplantation at the Perelman School of Medicine, University of Pennsylvania, and colleagues conducted a retrospective cohort study of 397 adult liver transplant (LT) recipients at University of Pennsylvania between January 2005 and September 2014.

David S. Goldberg

The goal of the study was to determine if pretransplant echocardiographic parameters were associated with posttransplant survival and increased risk for the development of cardiovascular events and chronic kidney disease (CKD). Patients with acute liver failure, without cirrhosis, retransplants and multiorgan transplant patients were excluded from the study.

“Despite advances in liver transplantation and preoperative risk stratification, there remains significant posttransplant morbidity and mortality from cardiovascular and renal disease. There are limited and conflicting data on the role of pretransplant echocardiography to predict these outcomes,” the researchers wrote.

Multivariable Cox regression models showed that tricuspid regurgitation grades higher than mild were associated with increased risk for posttransplant mortality (HR = 1.68; 95% CI, 1.03-2.75). Multivariable competing risk models showed that increasing pulmonary artery systolic pressure (PASP) was associated with increased risk for hospitalization due to myocardial infarction or heart failure (subHR per 5 mm Hg increase in PASP = 1.79; 95% CI, 1.48-2.17), as well as increased left ventricular ejection fraction (LVEF) associated with increased risk for stage 4 or 5 CKD (subHR = 1.11 per 5% increase in LVEF; 95% CI, 0.99-1.24. However, the LVEF and CKD association was not significant, according to researchers.

Further analysis showed that LVEF greater than 65% was the best cutoff for increased risk for CKD (subHR = 1.75; 95% CI, 1.06-2.89).

The researchers concluded: “Several pretransplant echocardiographic parameters were associated with posttransplant morbidity and mortality, suggesting that pretransplant echocardiography may be used as a tool to risk-stratify patients for posttransplant outcomes.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.