Risk factors associated with adverse cardiovascular events during orthotopic liver transplantation and the early post-transplant period.

Aim: To evaluate the incidence of severe adverse cardiovascular events during orthotopic liver transplantation and the early post-transplant period, and to determine the factors associated with these events.

Methods: We retrospectively reviewed the medical records of 291 patients who underwent orthotopic liver transplantation at University Center Merkur, Zagreb, Croatia, from 2013 to 2015. Data on corresponding donor characteristics were sourced from the Eurotransplant database. Severe adverse cardiovascular events were defined as myocardial infarction, malignant arrhythmia, pulmonary embolism, cardiac failure, cardiac arrest, and death.

Results: The incidence of severe adverse events was 8.9%. Univariate analysis demonstrated a positive predictive value linking severe adverse cardiovascular events with metabolic liver disease, an elevated model for end-stage liver disease, an international normalized ratio, and the preoperative administration of vasopressors. Multivariate analysis identified significant predictors of adverse events: liver metabolic diseases (odds ratio [OR] 4.88; 95% confidence interval [CI] 1.48-16.09; P=0.009), donor arterial hypertension (OR 2.68; 95% CI 1.01-7.18; P=0.049), prolonged cold ischemia duration (OR 1.22; 95% CI 1.01-1.49; P=0.044), and increased recipient age (OR 1.09; 95% CI 1.03-1.16; P=0.005).

Conclusion: The occurrence of severe adverse cardiovascular events is markedly greater than previously documented. We propose the use of a scoring system including known risk variables to identify patients at risk of adverse cardiovascular events, hence improving surveillance for an early intervention.