Liver Transplant Recipients With Heart Failure Require More Attention

Zahid Tarar, MD

New data being presented at the 2021 American College of Gastroenterology (ACG) Annual Meeting show patients with heart failure who are recipients of liver transplants are at an increased risk of adverse events, including death.

A team, led by Zahid I. Tarar, MD, University of Missouri School of Medicine, measured the effect of pre-existing heart failure on patient outcomes for individuals admitted to the hospital for liver transplants.

Comorbid Conditions

It is not uncommon for liver disease and heart failure to simultaneously occur because heart failure can lead to liver diseases, while liver diseases affect cardiac function.

The investigators used data from the National Inpatient Sample (NIS) between 2016-2018 of patients with a history of heart failure who underwent liver transplantation, only including those who were admitted for new liver transplants. There were 4546 patients included in the study, 3.8% (n = 870) of which had a history of heart failure.

The team used the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes to identify the patients included in the study.

Outcomes

The investigators sought primary outcomes of the effect of heart failure on mortality, transplant failure, and post-transplant infection, as well as secondary outcomes of the length of stay and total hospital charges.

The team performed multivariate logistic regression analysis and included several comorbidities of interest in the analysis, including previous history of cirrhosis, alcoholic abuse, stroke history, and chronic kidney disease history.

Patients with heart failure who underwent liver transplantation had higher odds of mortality (aOR, 2.3; P = 0.02; 95% CI, 1.14-4.69), as well as an increased length of hospital stay by 8 days (OR, 7.8; P <0.01; 95% CI, 3.86-11.92).

This patient group also incurred higher hospital charges (co-efficient, 35,273; P = 0.02; 95% CI, 13,141-57,405).

In addition, the older patients had higher odds of death (OR, 1.02; P = .001; 9% CI, 1.01-1.03).

However, the results were not statistically significant.

“In our study we found that pre-existing heart failure is associated with worse clinical outcomes in liver transplant recipients,” the authors wrote. “These patients had prolonged hospital stay and mortality. They also showed a tendency towards higher odds of transplant rejection.”

While the results were not statistically significant, the investigators said the results show the importance of monitoring heat-failure liver transplant recipients closer than the average post-liver transplant patients, including consideration of admission to cardiac intensive care units if needed.

The study, “Heart Failure Associated With Worse Outcome in Liver Transplant Recipients: A Nationwide Analysis,” was published online by ACG.