Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years

Simple item page
dc.contributor.authorKoshy, A.N.
dc.contributor.authorGow, P.J.
dc.contributor.authorHan, H.C.
dc.contributor.authorTeh, A.W.
dc.contributor.authorJones, R.
dc.contributor.authorTestro, A.
dc.contributor.authorLim, H.S.
dc.contributor.authorMcCaughan, G.
dc.contributor.authorJeffrey, G.P.
dc.contributor.authorCrawford, M.
dc.contributor.authorMacDonald, G.
dc.contributor.authorFawcett, J.
dc.contributor.authorWigg, A.
dc.contributor.authorChen, J.W.C.
dc.contributor.authorGane, E.J.
dc.contributor.authorMunn, S.R.
dc.contributor.authorClark, D.J.
dc.contributor.authorYudi, M.B.
dc.contributor.authorFarouque, O.
dc.date.issued2020
dc.description.abstractAims 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.
dc.description.statementofresponsibilityAnoop N Koshy, Paul J Gow, Hui-Chen Han, Andrew W Teh, Robert Jones, Adam Testro ... et al.
dc.identifier.citationEuropean Heart Journal - Quality of Care and Clinical Outcomes, 2020; 6(4):243-253
dc.identifier.doi10.1093/ehjqcco/qcaa009
dc.identifier.issn2058-5225
dc.identifier.issn2058-1742
dc.identifier.orcidLim, H.S. [0000-0002-8532-7891]
dc.identifier.urihttps://hdl.handle.net/2440/133099
dc.language.isoen
dc.publisherOxford University Press
dc.rights© The Author(s) 2020. Published on behalf of the European Society of Cardiology. All rights reserved.
dc.source.urihttps://doi.org/10.1093/ehjqcco/qcaa009
dc.subjectCardiac death
dc.subjectCardiovascular mortality
dc.subjectCirrhotic cardiomyopathy
dc.subjectLiver transplantation
dc.subjectLong term
dc.subjectTransplantation
dc.subject.meshHumans
dc.subject.meshCardiovascular Diseases
dc.subject.meshLiver Transplantation
dc.subject.meshPostoperative Period
dc.subject.meshCause of Death
dc.subject.meshSurvival Rate
dc.subject.meshRetrospective Studies
dc.subject.meshFollow-Up Studies
dc.subject.meshForecasting
dc.subject.meshMiddle Aged
dc.subject.meshAustralia
dc.subject.meshNew Zealand
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshEnd Stage Liver Disease
dc.titleCardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years
dc.typeJournal article
pubs.publication-statusPublished

Files

Collections

Medicine publications