Evaluating Accuracy of Cardiac Risk Stratification Pre-Liver Transplant

Abstract

Purpose: With graft failure decreasing and cardiac complications becoming a leading cause of morbidity and mortality, we aimed to evaluate current cardiac risk assessment and determine its accuracy in identifying liver transplantation (LT) candidates who are at risk for cardiac-related death. Methods: All patients who underwent LT at our institution between 2007 and 2010 were reviewed. Seven patients were identified to have died of a cardiac cause. Charts were reviewed to identify characteristics associated with an increase in cardiac risk. The Framingham risk assessment was recorded, which estimates the 10-year risk of developing coronary heart disease. Each patient's pre-transplant cardiac workup including stress test, ejection fraction, and coronary angiography were recorded. Finally, the cause of death was determined, and survival from LT to death was measured in days. Results: The 7 patients were all Caucasian. Four were males with a mean age of 59 (range 50 to 68). Demographics, pertinent medical history, and family history of our cohort are listed in Table 1. The mean survival post liver transplant was 53 days (range 0 to 198). The Framingham risk assessment, BMI, MELD, stress test results, and survival are shown in Table 2.Table: Demographics of transplant patients dying of cardiac eventsTable: Framingham risk score, BMI, MELD, stress tests, and survival time of patientsConclusion: For our cohort of patients who underwent LT and died of cardiac causes, traditional pre-transplant workup failed to identify them as highrisk patients. Cardiac stress tests were normal in all 7 patients, supporting the limited utility of this modality. Those patients with the lowest predicted 10 year risk of developing CAD by Framingham risk assessment had the shortest survival times demonstrating its poor correlation. The process of developing a standardized cardiac risk assessment protocol for transplant candidates and uniformity between transplant centers warrants further study.