Rise in Proportional Early Cardiovascular Mortality Following Liver Transplantation: Temporal Trends from the Australian & New Zealand Liver Transplant Registry

Background: Liver transplantation (LT) surgery poses a significant cardiovascular (CV) risk. Given the rising prevalence of non-alcoholic fatty liver disease and advancing age of LT candidates, delineating CV risk is increasingly important. We sought to characterise the incidence and modes of intraoperative and early (≤30days) CV death post-LT. Methods: Prospectively recorded outcome data were collected for all adult LTs in Australia and New Zealand between 1985–2017. Data was collected from six participating centres and compared between Era 1(1985–95), Era 2(1996–2006) and Era 3(2007–17). Results: Among, 4538 adult LTs, 201(4.4%) deaths including 38 (19%) CV deaths occurred in 30-days. All-cause mortality fell across the 3 Eras (10.4%, 5.1%, 2.2%, p < 0.001, Era 1–3, respectively). A reduction in overall early CV death was also noted (1.1%-1.2%-0.6%, p < 0.001). However, CV death as a proportion of all-cause 30-day mortality increased significantly (10.5%-21.8%-23.2%, p < 0.001). CV events were the leading cause of intra-operative mortality (40%) and second leading cause of overall early death (19%). Most common modes of CV death were cardiac arrest and congestive heart failure (44.7% and 23.7%, respectively, of CV deaths). Conclusion: CV events are a leading cause of operative and early mortality following LT. Despite reductions in absolute all-cause mortality over 30 years, the proportion of deaths due to CV causes continues to rise. Improvements in preoperative risk stratification are needed.