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.2021-11-112021-11-112020European Heart Journal - Quality of Care and Clinical Outcomes, 2020; 6(4):243-2532058-52252058-1742https://hdl.handle.net/2440/133099Aims 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.en© The Author(s) 2020. Published on behalf of the European Society of Cardiology. All rights reserved.Cardiac deathCardiovascular mortalityCirrhotic cardiomyopathyLiver transplantationLong termTransplantationHumansCardiovascular DiseasesLiver TransplantationPostoperative PeriodCause of DeathSurvival RateRetrospective StudiesFollow-Up StudiesForecastingMiddle AgedAustraliaNew ZealandFemaleMaleEnd Stage Liver DiseaseJournal article10.1093/ehjqcco/qcaa0092021-11-11564292Lim, H.S. [0000-0002-8532-7891]