Cirrhotic Cardiomyopathy Predicts New-onset Heart Failure Within the First Year After Liver Transplantation

BACKGROUND: Cirrhotic cardiomyopathy (CCM) has been redefined and linked to major adverse cardiovascular events (MACEs) after liver transplantation (LT). However, its impact on post-LT heart failure (HF) and survival remains unclear. This study assessed the association between CCM and MACE post-LT. METHODS: We conducted a retrospective cohort study of adults with cirrhosis undergoing deceased-donor LT at a state-wide center between 2010 and 2022. CCM was defined using the Cirrhotic Cardiomyopathy Consortium (CCC-2020) criteria. The primary outcome was new-onset MACE, including HF, within 12-mo post-LT. The secondary outcome was long-term survival. RESULTS: Among 362 patients, 57 (16%) had CCM. MACE occurred in 46 (13%) of 362, including 15 cases of HF. Patients with CCM had higher MACE incidence than non-CCM (33% versus 9%; P < 0.001), driven by HF (21% versus 1%; P < 0.001). CCM independently predicted MACE (odds ratio 4.5 [95% CI, 2.3-9.0]; P < 0.001) and HF (odds ratio 22.8 [95% CI, 6.0-86.2]; P < 0.001); age was also independently associated with MACE. Late-onset HF (>30 d) was more severe than perioperative HF (≤30 d). CCM was associated with a 2.1-d longer intensive care unit length of stay (95% CI, 0.1-4.1; P = 0.04), but not other perioperative outcomes, graft loss, or mortality for the 4.7-year follow-up (interquartile rang 2.5-6.9 y). CONCLUSIONS: Pre-LT CCM, by CCC-2020 criteria, was associated with a 4-fold higher risk of post-LT MACE, primarily because of HF. Other MACE and survival were not impacted. Further research is required to identify which patients with CCM are at the greatest risk of HF, the impact of age, and whether targeted intervention or surveillance can mitigate this.