Factors associated with major adverse cardiovascular events after liver transplantation among a national sample
Open accessAbstract
Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multicenter study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplant Network was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (February 2002 to December 2012). MACE was defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism, and/or stroke. Of 32 810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days, respectively. Recipients with MACE were older and more likely to have a history of nonalcoholic steatohepatitis (NASH), alcoholic cirrhosis, MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age >65 years (incidence rate ratio [IRR] 2.8, 95% confidence interval [95% CI] 1.8-4.4), alcoholic cirrhosis (IRR 1.6, 95% CI 1.2-2.2), NASH (IRR 1.6, 95% CI 1.1-2.4), pre-LT creatinine (IRR 1.1, 95% CI 1.04-1.2), baseline AF (IRR 6.9, 95% CI 5.0-9.6) and stroke (IRR 6.3, 95% CI 1.6-25.4) were independently associated with MACE. MACE was associated with lower 1-year survival after LT (79% vs. 88%, p < 0.0001). In a national database, MACE occurred in 11% of LT recipients and had a negative impact on survival. Pre-LT AF and stroke substantially increase the risk of MACE, highlighting potentially high-risk LT candidates.
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Liver transplant recipients with T2D and chronic kidney disease are at the highest risk for cardiovascular events.
“Cardiovascular complications are the second most common cause of non-hepatic mortality in liver transplant recipients, 512 and those with T2D 513 and chronic kidney disease 514 are at the highest risk for cardiovascular events.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [513]
The Results section (page unavailable) reports that recipients with early cardiovascular events had a higher prevalence of chronic renal disease than those without events (19% versus 14%), and that pre-transplant creatinine independently predicted early events. It does not identify recipients with chronic kidney disease as being at the highest risk; atrial fibrillation and prior stroke had much larger reported risk estimates. The T2D portion is attached to a different citation. (LLM, conf=0.88)
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- Authors
- VanWagner, L. B., Serper, M., Kang, R., Levitsky, J., Hohmann, S., Abecassis, M., Skaro, A., & Lloyd-Jones, D. M.
- Affiliations
- Northwestern University (US)
- Hospital of the University of Pennsylvania (US)
- University HealthSystem Consortium (US)
- Corresponding author
- VanWagner, L.B.
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 16
- Issue
- 9
- Pages
- 2684-2694
- ISSN
- 1600-6135 (ISSN-L)
- PMC
- PMC5215909
- OpenAlex
- W2294860106
- Cited by
- 180
- References
- 49
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 21 · 2023: 14 · 2022: 22 · 2021: 21 · 2020: 20 · 2019: 16 · 2018: 19 · 2017: 14 · 2016: 3 · 2014: 1
- FWCI
- 19.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1 F32 HL116151‐01)
- American Liver Foundation
- National Center for Advancing Translational Sciences (KL2TR001424)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- liver transplantation, major adverse cardiovascular events, atrial fibrillation, stroke, alcoholic cirrhosis, nonalcoholic steatohepatitis, post-transplant survival, risk factors
- MeSH terms
- Adolescent, Adult, Aged, Atrial Fibrillation, Female, Follow-Up Studies, Graft Survival, Heart Failure, Humans, Liver Diseases, Male, Middle Aged, Myocardial Infarction, Prognosis, Retrospective Studies, Risk Factors, Liver Transplantation, Risk Assessment, Young Adult
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