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https://hdl.handle.net/2440/133099
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Type: | Journal article |
Title: | Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years |
Author: | Koshy, A.N. Gow, P.J. Han, H.C. Teh, A.W. Jones, R. Testro, A. Lim, H.S. McCaughan, G. Jeffrey, G.P. Crawford, M. MacDonald, G. Fawcett, J. Wigg, A. Chen, J.W.C. Gane, E.J. Munn, S.R. Clark, D.J. Yudi, M.B. Farouque, O. |
Citation: | European Heart Journal - Quality of Care and Clinical Outcomes, 2020; 6(4):243-253 |
Publisher: | Oxford University Press |
Issue Date: | 2020 |
ISSN: | 2058-5225 2058-1742 |
Statement of Responsibility: | Anoop N Koshy, Paul J Gow, Hui-Chen Han, Andrew W Teh, Robert Jones, Adam Testro ... et al. |
Abstract: | Aims There has been significant evolution in operative and post-transplant therapies following liver transplantation (LT). We sought to study their impact on cardiovascular (CV) mortality, particularly in the longer term. Methods and results A retrospective cohort study was conducted of all adult LTs in Australia and New Zealand across three 11-year eras from 1985 to assess prevalence, modes, and predictors of early (≤30 days) and late (>30 days) CV mortality. A total of 4265 patients were followed-up for 37 409 person-years. Overall, 1328 patients died, and CV mortality accounted for 228 (17.2%) deaths. Both early and late CV mortality fell significantly across the eras (P < 0.001). However, CV aetiologies were consistently the leading cause of early mortality and accounted for ∼40% of early deaths in the contemporary era. Cardiovascular deaths occurred significantly later than non-cardiac aetiologies (8.8 vs. 5.2 years, P < 0.001). On multivariable Cox regression, coronary artery disease [hazard ratio (HR) 4.6, 95% confidence interval (CI) 1.2-21.6; P = 0.04] and era of transplantation (HR 0.44; 95% CI 0.28-0.70; P = 0.01) were predictors of early CV mortality, while advancing age (HR 1.05, 95% CI 1.02-1.10; P = 0.005) was an independent predictors of late CV mortality. Most common modes of CV death were cardiac arrest, cerebrovascular events, and myocardial infarction. Conclusion Despite reductions in CV mortality post-LT over 30 years, they still account for a substantial proportion of early and late deaths. The late occurrence of CV deaths highlights the importance of longitudinal follow-up to study the efficacy of targeted risk-reduction strategies in this unique patient population. |
Keywords: | Cardiac death Cardiovascular mortality Cirrhotic cardiomyopathy Liver transplantation Long term Transplantation |
Rights: | © The Author(s) 2020. Published on behalf of the European Society of Cardiology. All rights reserved. |
DOI: | 10.1093/ehjqcco/qcaa009 |
Published version: | http://dx.doi.org/10.1093/ehjqcco/qcaa009 |
Appears in Collections: | Medicine publications |
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