Predictors of cardiovascular events after liver transplantation: a role for pretransplant serum troponin levels.

Publication Type:

Journal Article

Source:

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, Volume 17, Issue 1, p.23-31 (2011)

Keywords:

Adultdigestive disease, digestive deseases Age Factorsdigestive disease, digestive deseases Biological Markersdigestive disease, digestive deseases C-Reactive Proteindigestive disease, digestive deseases Cardiovascular Diseasesdigestive disease, digestive deseases Diabetes Complicationsdigestive disease, digestive deseases Femaledigestive disease, digestive deseases Humansdigestive disease, digestive deseases Liver Transplantationdigestive disease, digestive deseases Maledigestive disease, digestive deseases Middle Ageddigestive disease, digestive deseases Minnesotadigestive disease, digestive deseases Predictive Value of Testsdigestive disease, digestive deseases Preoperative Caredigestive disease, digestive deseases Proportional Hazards Modelsdigestive disease, digestive deseases Retrospective Studiesdigestive disease, digestive deseases Risk Assessmentdigestive disease, digestive deseases Risk Factorsdigestive disease, digestive deseases Troponin Idigestive disease, digestive deseases Up-Regulation

Abstract:

Cardiovascular complications are major causes of morbidity and mortality after liver transplantation. Identifying candidates at highest risk of postoperative complications is a cornerstone of optimizing outcomes and utility. Using traditional cardiac risk factors in addition to C-reactive protein (CRP) levels, troponin levels, and echocardiographic parameters before transplantation, we sought to define cardiac risk so that we could predict cardiovascular events after transplantation. From December 1998 to December 2001, 230 adult patients who underwent liver transplantation with a median follow-up of 8.2 years were studied. The risk factors for cardiac disease were as follows: male gender with a mean age of approximately 50 years (57%), smoking history (60%), diabetes (23%), hypertension (19%), elevated troponin (25%), elevated CRP (25%), and preexisting cardiac disease (16%). Fifty-nine cardiac events occurred over 8.2 years. Risk factors (univariate analysis) for first cardiac events included age in decades [hazard ratio (HR) = 1.31, P = 0.047], diabetes (HR = 2.20, P = 0.004), prior cardiovascular disease (HR = 4.77, P < 0.0001), a troponin I level > 0.07 ng/mL (HR = 2.00, P = 0.023), left ventricular hypertrophy (HR = 2.06, P = 0.047), stress wall abnormalities (HR = 2.25, P = 0.018), and ischemia on stress imaging (HR = 2.89, P = 0.015). Multivariate analysis confirmed age, diabetes, a troponin I level > 0.07, and prior cardiac disease as independent risk factors for posttransplant cardiac events. In conclusion, pretransplant elevated troponin levels, diabetes, and a history of cardiovascular disease, alone or in combination, are strongly associated with the occurrence of posttransplant cardiovascular events.