The Predictive Value Of Revised Diastolic Dysfunction In Outcomes Of Liver Transplantation

Objective: Liver transplantation(LT)is an effective treatment of end-stage liver disease.Diastolic dysfunction(DD),one of the earliest signs of cirrhotic cardiomyopathy(CCM),is included in the revised 2019 CCM criteria.Nonetheless,relevant research regarding the effects of revised DD on post-liver transplantation(LT)outcomes remains limited.Methods: The retrospective study enrolled patients who underwent LT for decompensated cirrhosis from January 2018 to March 2021.Patients were divided into DD and non-DD groups based on the revised 2019 CCM criteria.The clinical data were collected.Based on the purpose to reduce the selection bias and eliminate the impacts of confounding factors,the 1:2 propensity score matching(PSM)was used with the caliper value of 0.02.Patients were followed up with,for at least 1 year post-LT;cardiovascular adverse events(AEs)and survival status were recorded.Survival status was assessed using Kaplan-Meier curves and compared by the log-rank test.Cox proportional hazards regression model and Logistic regression analysis were conducted to identify independent and predictive factors for poor outcomes.Results:1.In total,606 patients were screened for eligibility,375 were excluded based on the exclusion criteria.Of 231 patients enrolled in the analysis,153 were included in the DD group.The mean age was 51.5±9.5 years,and men accounted for 81.8%.Moreover,24 patients with DD developed perioperative cardiovascular AEs,and 19 patients with DD died within 1 year,post-LT.Compared with no DD group,the DD group were more likely to be older(P=0.004)and with a presence of diabetes(P=0.018)and hypertension(P=0.007)before PSM.After PSM,97 and 60 patients were diagnosed with and without DD,respectively.No difference was observed between the two groups in the demographic baseline characteristics(P>0.05).2.In a univariate analysis,higher levels of leukocyte(P=0.009),CA19-9(P=0.041)and Child-Pugh class(P=0.045)were observed in the DD group after PSM.Patients with DD were likely to have more echocardiographic abnormalities.There were significant differences in the early diastolic mitral annular tissue velocity(e’,P=0.000),early diastolic trans-mitral flow to early diastolic mitral annular tissue velocity(E/e’,P=0.000),pulmonary arterial systolic pressure(PASP,P=0.000),tricuspid regurgitation maximum velocity(TRV,P=0.000),left ventricular posterior wall(LVPW,P=0.032),interventricular septum(IVS,P=0.003)after PSM.3.Patients with DD had longer intensive care unit(ICU)stays(P=0.001),higher perioperative cardiovascular AEs(P=0.023),and higher mortality rates(P=0.013)than those without DD after PSM.The KM curves revealed that the patients with DD had a shorter OS(log rank,P=0.013).4.In a multivariate analysis,interventricular septum(IVS),left atrial volume index(LAVI),and serum potassium levels were independent prognostic factors of perioperative cardiovascular AEs,while a decreased e’,increased neutrophil-to-lymphocyte ratio(NLR)and tumor markers were predictors of mortality within 1 year post-LT after PSM(P<0.05).Conclusions:1.More echocardiographic abnormalities were observed in DD group before operation.2.In PSM analysis,multiple risk factors including IVS,LAVI,e’,potassium,and NLR collectively contributed to perioperative cardiovascular AEs and 1-year mortality,which provides a new method for early screening.3.Decompensated cirrhosis with DD accelerates perioperative cardiovascular AEs and1-year post-transplantation mortality rates,highlighting the need for closer post-LT monitoring and management.Appropriate precedence in decompensated cirrhosis with DD on the waiting list should be considered to ensure timely diagnosis.