Incidence of and Risk Assessment for Adverse Cardiovascular Outcomes Following Liver Transplantation: A Systematic Review.

Background: Cardiovascular events represent a major source of morbidity and mortality following liver transplantation and will likely increase given the aging population and nonalcoholic fatty liver disease as a leading indication for transplant. The optimal cardiovascular risk stratification approach in this evolving patient population remains unclear. The aims of this systematic review are to: 1) refine the definition 2) characterize the incidence, and 3) identify risk factors for cardiovascular events post liver transplantation. Additionally, we evaluated performance characteristics of different cardiac testing modalities. Methods: MEDLINE via PubMed, EMBASE, Web of Science and Scopus were searched for studies published between 2002 -2016 (MELD era). Two authors independently reviewed articles to select eligible studies and performed data abstraction. Results: 29 studies representing 57,493 patients from 26 unique cohorts were included. Definitions of cardiovascular outcomes were highly inconsistent. Incidence rates were widely variable: 1-41% for outcomes 6 months. Multivariate analyses demonstrated that older age and history of cardiac disease were the most consistent predictors of cardiovascular events posttransplant (significant in 8/23 and 7/22, studies respectively). Predictive capacity of various cardiac imaging modalities was also discrepant. Conclusions: The true incidence of cardiovascular outcomes post liver transplant remains unknown in large part due to lack of consensus regarding outcome definition. Overall, poor data quality and gaps in knowledge limit the ability to clearly identify predictors of outcomes, but existing data supports a more aggressive risk stratification protocol for patients of advanced age and/or with preexisting cardiac disease. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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