The incidence of heart failure in Swedish liver transplant recipients: a Nationwide study

Background The incidence of heart failure (HF) in liver transplant (LT) recipients is reported to be high, although this is not supported by a substantial body of evidence. Purpose To investigate the incidence of HF among Swedish LT recipients from 1987 to 2022. Methods Data from national health inpatient registries, including mortality data, were used to identify all Swedish LT recipients. HF was defined by ICD 9 and 10 codes during hospital admissions. Incidence rates per 1,000 patient-years were calculated, and Cox regression analysis was employed to estimate the hazard ratio for new HF events and mortality. Statistical models adjusted for cardiovascular risk factors were used to assess outcomes. Results A total of 3,323 LT recipients (median age 54 years, 37% women) without prior HF were followed for a median of 3 years post-transplant. Among them, 382 (11%) developed HF, resulting in an incidence rate of 19 per 1,000 patient-years. In multivariable-adjusted analyses, coronary artery disease (CAD), lung disease, and atrial fibrillation (AF) were identified as independent predictors of new HF events (Figure 1). During a median follow-up period of 8 years, 1,502 (44%) LT recipients died, with an incidence rate of 47 per 1,000 patient-years of whom 296 (20%) had developed HF. CAD, lung disease, and AF significantly increased mortality risk when combined into a composite risk factor for HF (Figure 2). Conclusion CAD, lung disease, and AF are predictors of HF risk following liver transplantation. A substantial proportion of deaths within eight years of LT are preceded by a diagnosis of HF, and this diagnosis may not have been recorded in many additional cases.Figure 1.New onset of heart failure. Figure 2.All-cause mortality