Anoop N Koshy1,2, Paul J Gow2,3, Hui-Chen Han1,2, Andrew W Teh1,2, Robert Jones2,3, Adam Testro2,3, Han S Lim1,2, Geoffrey McCaughan4,5, Gary P Jeffrey6,7, Michael Crawford4,5, Graeme Macdonald8,9, Jonathan Fawcett8,9, Alan Wigg10, John W C Chen10, Edward J Gane11, Stephen R Munn11, David J Clark1,2, Matias B Yudi1,2, Omar Farouque1,2. 1. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia. 2. The University of Melbourne, Parkville, Victoria, Australia. 3. Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia. 4. Department of Liver Transplantation, Royal Prince Alfred Hospital, Sydney, Australia. 5. University of Sydney, Sydney, Australia. 6. Department of Liver Transplantation, Sir Charles Gardiner Hospital, Perth, Australia. 7. School of Medicine, University of Western Australia, Nedlands, Australia. 8. Department of Liver Transplantation, Princess Alexandra Hospital, Brisbane, Australia. 9. School of Medicine, The University of Queensland, Brisbane, Australia. 10. Department of Liver Transplantation, Flinders Medical Centre, Adelaide, Australia. 11. Auckland City Hospital, Auckland, New Zealand.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Manhal Izzy; Brett E Fortune; Marina Serper; Nicole Bhave; Andrew deLemos; Juan F Gallegos-Orozco; Cesar Guerrero-Miranda; Shelley Hall; Matthew E Harinstein; Maria G Karas; Michael Kriss; Nicholas Lim; Maryse Palardy; Deirdre Sawinski; Emily Schonfeld; Anil Seetharam; Pratima Sharma; Jose Tallaj; Darshana M Dadhania; Lisa B VanWagner Journal: Am J Transplant Date: 2022-03-31 Impact factor: 9.369
Authors: Anoop N Koshy; Paul J Gow; Adam Testro; Andrew W Teh; Jefferson Ko; Han S Lim; Hui-Chen Han; Laurence Weinberg; Lisa B VanWagner; Omar Farouque Journal: Am J Transplant Date: 2021-02-08 Impact factor: 9.369
Authors: Sanjana Nagraj; Spyros Peppas; Maria Gabriela Rubianes Guerrero; Damianos G Kokkinidis; Felipe I Contreras-Yametti; Sandhya Murthy; Ulrich P Jorde Journal: World J Transplant Date: 2022-07-18