Frequency and Significance of Acute Heart Failure Following Liver Transplantation

Reversible cardiomyopathy has been reported in patients after liver transplantation. However, there are few data on the incidence, risk factors, and prognosis of this condition. Liver transplantation recipients who underwent preoperative right- and left-sided cardiac catheterization as well as preoperative transthoracic echocardiography from 2001 to 2005 were identified. Eighty-six patients met the outlined criteria and were included in the study. The incidence of severe heart failure (HF) after transplantation in this population was 6 of 86 (approximately 7%). Patients who developed HF were slightly older (mean age 61.2 ± 8.9 vs 55.4 ± 9.2 years, p = 0.08) but had similar preoperative ejection fractions (60 ± 5% vs 57 ± 8%, p = 0.22) and comparable systemic arterial blood pressure (116 ± 22/62 ± 11 vs 127 ± 9/66 ± 9, p >0.1). In addition, the severity of liver disease as measured by the model for end-stage liver disease score was not different between the 2 groups (23.9 ± 9.7 vs 26 ± 10.7, p = 0.5). There was also no significant difference in the preoperative cardiac index (3.8 ± 1 vs 3.6 ± 1.5 L/min/m2, p = 0.9) or pulmonary artery wedge pressure (13.6 ± 5.8 vs 15.3 ± 2.8 mm Hg, p = 0.42). The incidence of alcohol use as the presumed cause of liver failure was equivalent in the 2 groups (33% vs 25%, p = 0.65). The patients who developed HF did have significantly higher preoperative mean pulmonary arterial systolic pressures (43 ± 10 vs 30 ± 9 mm Hg, p = 0.02) and right ventricular systolic pressures (44 ± 13 vs 34 ± 8 mm Hg, p = 0.05). In conclusion, severe systolic HF may occur after liver transplantation in patients without traditional risk factors for HF. This study suggests that those patients with preoperative elevated right-sided cardiac pressures, as well as older patients, may be at excess risk for developing HF after transplantation.