Introduction:
The 2012 AHA/ACCF expert consensus statement regarding cardiac evaluation of liver transplant candidates specifies 7 risk factors for identifying candidates for cardiac evaluation prior to liver transplantation. These include age > 60 yrs, hypertension, diabetes, smoking, dyslipidemia, prior cardiovascular disease, and left ventricular hypertrophy. The prognostic value of these risk factors in predicting major adverse cardiac events (MACE) has not been established. Furthermore, the optimal threshold of the sum of risk factors to predict MACE has not been determined.
Hypothesis:
Risk factors set forth by the AHA/ACCF can predict MACE in liver transplant candidates. We sought to identify an optimal threshold sum of risk factors to predict MACE.
Methods:
We conducted a retrospective cohort study of consecutive liver transplant recipients who were followed for MACE, defined as a composite of cardiac death, myocardial infarction, or coronary revascularization. Kaplan-Meier plots, log-rank test, and Cox regression models were used in outcome analyses.
Results:
We retrospectively followed 193 consecutive liver transplant recipients (40% female, mean age 55±10 yrs) for a mean of 51±29 months, during which 24 MACE were observed. Having ≥2 AHA/ACCF risk factors was associated with increased MACE risk (HR, 2.75, P=0.02), whereas having ≥3 risk factors was associated with greater MACE risk (HR, 4.14, P<0.001), Figure 1. Using ≥1 risk factor threshold provided insignificant predictive value of event-free survival (P=0.29).
Conclusion:
This study provides prognostic validation of risk factors set forth by the AHA/ACCF consensus statement for cardiac evaluation in liver transplant candidates. Having ≥2 risk factors is most sensitive for predicting MACE and seems optimal for triggering CAD surveillance in asymptomatic liver transplant candidates.
International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients
