A comparison between patients with various etiologies of cirrhosis and examination of cardiac risk factors limiting survival to liver transplantation

Background & AimsObjectives of this retrospective cohort study were to assess differences in patient survival between etiologies of cirrhosis while on the waitlist for liver transplantation (LT), and to identify cardiac risk factors that predict survival failure while on the waitlist for LT.MethodsThis single-center retrospective cohort design included adult patients who were listed for LT at a tertiary academic hospital with a high-volume liver transplant center.ResultsOf the 653 patients listed for LT during the study period, 507 (77.6%) survived to transplant and 146 (22.4%) died or clinically deteriorated prior to transplant. Cumulative incidence of death or clinical deterioration did not differ statistically between patient groups (log rank p = .11). In multivariate analysis, compared to patients with NAFLD, there were no significant differences between patients with alcoholic cirrhosis (HR .95, 95%, CI, .62-1.45), cryptogenic cirrhosis (HR 1.31, 95%, CI, .77-2.23), or hepatitis C cirrhosis (HR 1.12, 95%, CI, .66-1.90). However, higher MELD scores (HR = 1.52, 95% CI, 1.12-1.19), severe coronary artery disease (HR = 2.09 95% CI, 1.23-3.55), and tricuspid regurgitation (HR = 2.62, 95% CI, 1.31-5.26) were independently associated with increased risk for survival failure to LT.ConclusionsThe presence of severe coronary artery disease and tricuspid regurgitation at the time of listing for transplant are associated with survival failure while on the LT waitlist across etiologies of liver disease. Diagnostic assessment of coronary and valvular disease should be considered in all patients undergoing evaluation for LT, such as cardiac catheterization and/or stress echocardiogram.

Automated summary

This retrospective cohort study aimed to assess differences in patient survival on the waitlist for liver transplantation based on etiologies of cirrhosis, and to identify cardiac risk factors that predict survival failure during the waitlist period. The study found that severe coronary artery disease and tricuspid regurgitation at the time of listing were associated with increased risk for survival failure, regardless of the etiology of liver disease. The study suggests that diagnostic assessment of coronary and valvular disease should be considered for all patients undergoing evaluation for liver transplantation.