Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

Although most patients presenting for liver transplantation have normal left ventricular function, some develop left ventricular failure after transplantation. The primary objective of our study was to determine the predictors of systolic heart failure (HF) occurring immediately after liver transplantation. Its etiology, prospects of recovery, and factors associated with nonrecovery were also studied. Liver transplantations performed at our institution from January 2006 to February 2015 were evaluated using prospectively collected institutional registries. Patients with echocardiographically documented decline in ejection fraction to <45% within 6 months after liver transplantation were identified. Four controls were chosen per case: matched for age, gender, transplant year, and model for end-stage liver disease score. Conditional multivariable logistic regression was used for primary analysis and nonparametric tests for comparison between groups. In a cohort of 1284 adult patients, 45 cases and 180 controls were identified. Diastolic dysfunction (DD) was an independent predictor (OR 5.26, 95% CI 1.03-28.57, P = .04) of systolic HF in multivariable analysis. Stress-induced cardiomyopathy was the most common etiology. Left ventricular function recovered in 21 patients. Pretransplant DD decreased the chances of recovery (P = .05). In conclusion, patients with pretransplant DD need close post-transplant follow-up for timely identification of HF.