Abstract 15563: Impact of Cardiovascular Events on Short and Long-Term Mortality Following Liver Transplantation

Introduction:Present-day patients undergoing liver transplantation are older and have a higher risk of peri-operative cardiovascular events. However,data on the exact burden and impact of cardiovascular events following liver transplantation is still limitedHypothesis:We aimed to study the frequency of adverse cardiovascular events as well as their contribution to mortality in the setting of liver transplantationMethods:This is retrospective analysis of data from a prospectively recorded database of patients who underwent liver transplantation at Cleveland Clinic between 2008- Jan 2019. In total there were 1526 patients in the final analysisResults:Total mortality was 19.9% over a mean follow-up of 4.56 ? 3.3 years following liver transplantation. 30-day mortality was 3.3%. Median patient age was 57. Post-transplant cardiovascular complications included stroke (4.4% cases), myocardial infarction (MI) (4.5%), acute heart failure (6.9%) and arrhythmia (17.4%). Cardiovascular events associated with the highest hazard for long term mortality included acute stroke with an adjusted hazard ratio (HR) of 2.02 (Confidence Interval, CI, 1.3-3.2, p=0.002), acute MI with an adjusted HR of 1.99 (CI 1.16-3.43, p=0.012) and post-transplant acute heart failure with adjusted HR of 1.79 (CI 1.24-2.6, p=0.002). The composite of MACE (MI/Stroke/Heart failure) was noted in 13.3% patients with adjusted HR of 2.58 (CI 1.9-3.6; p <0.001). Occurrence of MACE was also associated with significant odds for 30-day mortality (Odds ratio 5.13, CI 1.3-20.5, p=0.02). Presence of diabetes mellitus was strongly associated with occurrence of MACE (adjusted HR 2.011, CI 1.44-2.8; p<0.001)Conclusions:There is a high burden of major adverse cardiovascular events following liver transplantation with significant impact on short and long-term mortality, specially in diabetic patients, highlighting the importance of careful cardiovascular optimization prior to transplantation.