Prevalence of cirrhotic cardiomyopathy in liver transplant recipients: impact on pre- and post-transplant mortality

Abstract

Introduction and objectives: Cirrhotic cardiomyopathy (CCM) is defined as the presence of cardiac dysfunction in patients with cirrhosis in the absence of pre-existing heart disease. Reported prevalence thus far has varied between 17.5% and 35%, depending on the studies. In 2020, diagnostic criteria were revised based on imaging advances. The aim of this study was to evaluate the prevalence of CCM and its impact on overall mortality on the waiting list and post-transplantation.

Materials and methods: A prospectively recorded database was retrospectively analyzed. Consecutive adult patients who were evaluated and placed on the waiting list for liver transplantation (LT) from 2019 to 2023 were enrolled. Survival curves for patients with and without cirrhotic cardiomyopathy were constructed using the Kaplan-Meier method, and differences were compared by the Log-rank test. Multiple regression analysis was performed by the Cox proportional hazards model.

Results: A total of 451 patients were assessed, of whom 389 (86.3%) met inclusion criteria. The median age was 55 years (IQR 46-61) with 236 (60.7%) males. The most common etiology of cirrhosis was hepatitis C, 110/389 (28.3%). The prevalence of CCM was 16.2% (63/389). Thirty-seven patients (9.5%) met systolic criteria, and 27 (6.9%) met diastolic criteria for CCM. No mean differences were found in MELD-Na (15, IQR 11-19, vs 14, IQR 10-16.5, p0.1) or decompensations. The presence of hepatocellular carcinoma was higher in the CCM group (44.4% vs. 22.1% p<0.01).The median overall survival time on the waitlist was longer in the group without CCM compared to that in the CCM group (32 vs 22 months, p=0.04). In Cox regression analysis, the presence of CCM (HR 1.71 CI95% 1.09-2.68 p0.02), HCC (HR 2.37, CI95% 1.47-3.82 p<0.001) and higher MELD-Na (HR 1.14 CI95% 1.10-1.18, p<0.001) were predictors of mortality on the waiting list. There were no significant differences in survival between the groups post-transplantation.

Conclusions: Our study revealed a lower prevalence of CCM in liver transplant candidates compared with previous reports. Moreover, it underscores that CCM was an independent predictor of mortality on a liver transplantation waitlist, highlighting its significant clinical implications. Further research is imperative to elucidate its precise impact on post-transplant survival.

Keywords: Cardiovascular; Cirrhotic cardiomyopathy; Diagnosis; Heart failure; Major adverse cardiac events; Orthotopic liver transplant; Transthoracic echocardiography.