Meeting abstract

https://doi.org/10.15836/ccar2019.232

Pretransplant echocardiographic findings as predictors of late adverse outcomes following liver and kidney transplantation

Zrinka Sertić orcid.org/0000-0002-4534-4283 ; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia
Tomislav Letilović ; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia; University Hospital “Merkur”, Zagreb, Croatia
Mladen Knotek ; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia; University Hospital “Merkur”, Zagreb, Croatia
Tajana Filipec Kanižaj ; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia; University Hospital “Merkur”, Zagreb, Croatia
Mario Stipinović ; University Hospital “Merkur”, Zagreb, Croatia
Darko Počanić ; University Hospital “Merkur”, Zagreb, Croatia
Inga Starovečki ; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia
Darko Vujanić ; University Hospital “Merkur”, Zagreb, Croatia
Helena Jerkić ; University Hospital “Merkur”, Zagreb, Croatia

Abstract

Introduction: Transthoracic echocardiography (TTE) is recommended as the standard of care in evaluation
of cardiovascular (CV) disease in liver (LT) and kidney (KT) transplant candidates.1,2 Guidelines
for preoperative CV assessment are oriented at the immediate perioperative period and non-ischemic
CV processes that would predict poor outcomes after LT and KT are defined less clearly. Aim: to establish
whether ≥moderate mitral (MR), tricuspid regurgitation (TR) or ≥mild aortic stenosis (AS) on
pretransplant TTE are associated with mortality, graft survival or major CV adverse events (MACE) in
the late postoperative period (>30 days).
Patients and Methods: Patients were stratified into cohorts based on the presence of ≥moderate MR,
TR and ≥mild AS. Exclusion criteria was loss to follow up, incomplete TTE findings and death within 30
days of transplantation. MACE were defined as stroke, myocardial infarction (MI) or heart failure. Patient
survival was defined as time from transplantation to death or last follow-up and graft survival as
time from transplantation to last follow-up, death, graft dysfunction or re-transplantation. Outcomes
of interest were compared between cohorts via logistic or Cox regression.
Results: 306 LT (median age 59, IQR 53-64) and 196 KT patients were included (median age 52, IQR 40-
61). Median follow up was 36 months for LT (range 14.3 – 55.9), 40,5 months for KT (range 18-64.9). MACE
occurred in 4.25% LT and 4.59% KT recipients. Upon univariate analysis AS was associated with MACE
in KT recipients but crossed the significance level after adjusting for common confounders (age, sex,
hypertension, diabetes, smoking). 11.76% LT and 9.69% KT recipients died. The most common cause of
death was sepsis. MR was found to be associated with LT patient survival, but the association was lost
after adjusting for age. In an age adjusted model MR was found to be associated with KT patient survival
(HR 2.97, 95% CI 1.06-8.26, P=0.037). Graft survival was not associated with any potential predictors.
Conclusion: Associating TTE findings with adverse outcomes after LT and KT might help distinguish
patients who would benefit from closer management in the late postoperative period. Moderate or more
severe MR was found to be associated with late mortality in KT recipients, however the significance of
this is yet to be determined in larger sample studies.

Keywords

liver transplantation; kidney transplantation; mitral regurgitation; tricuspid regurgitation; aortic stenosis.

Hrčak ID:

226701

URI

https://hrcak.srce.hr/226701

Publication date:

15.10.2019.

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