S1078 Heart Failure Associated With Worse Outcome in Liver Transplant Recipients: A Nationwide Analysis

Abstract

Introduction: Liver disease and heart failure frequently occur concomitantly. Heart failure can lead to liver diseases and liver diseases can affect cardiac function. In our nationwide study, we have tried to measure the effect of pre-existing heart failure on hospital-based outcomes of patients who are admitted for liver transplant. Methods: We examined the national inpatient sample (NIS) from 2016-2018. Patients with history of heart failure who underwent liver transplantation were identified. We only included those who were admitted for new liver transplants. We used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes to identify these patients. The primary outcomes we studied are effect of heart failure on mortality, transplant failure and post-transplant infection. Secondary outcomes of measurement were length of stay and total hospital charges. Utilizing STATA MP 16.1 we performed multivariate logistic regression analysis. Various comorbidities including previous history of cirrhosis, alcohol abuse,stroke and chronic kidney disease were included in the study.Data was considered statistically significant if p-value was < 0.05. Results: A total 4546 patients were included in the study, of which 870 (3.8%) had a history of heart failure.In multivariable regression analysis, patients who had heart failure and underwent liver transplantation had more odds of death (aOR 2.3, p= 0.02, 95% CI, 1.14 - 4.69) and increased length of stay by 8 days (OR 7.8, p= < 0.01 , 95% CI 3.86 – 11.92). These patients also incurred more hospital charges (co-efficient 35273, p= 0.02, 95% CI,13141 - 57405). Older study population had higher odds of death (OR 1.02, p= 0.001, 95% CI 1.01 – 1.03).We studied the post-transplant complications and rejection in patients with heart failure, and found that there were less odds of post-transplant complications like infection in heart failure patients but more odds of rejection/failure, but these results were not statistically significant. Conclusion: In our study we found that pre-existing heart failure is associated with worse clinical outcomes in liver transplant recipients. These patients had prolonged hospital stay and mortality. They also showed a tendency towards higher odds of transplant rejection. This study shows the significance of monitoring heart-failure liver transplant recipients more closely than the average liver post-liver transplant patients. This includes considering admission to cardiac intensive care units if critical.Table 1.: Adjusted odds of post liver transplant complications in Heart failure patients.