P- 104 EXPERIENCE AND CARDIOVASCULAR OUTCOMES IN POST-LIVER TRANSPLANT PATIENTS AT A REFERENCE TRANSPLANT CENTER IN COLOMBIA

Introduction and Objectives

Liver transplant patients require a vast and complex evaluation prior to transplant surgery. Hemodynamic evaluation by Doppler echocardiography is important in the identification of systolic/diastolic alterations as a predictor of post-liver transplant outcomes, from cardiovascular alterations to graft dysfunction and mortality. This study aimed to describe the relationship between the hemodynamic variables evaluated by Doppler echocardiography and post-transplant liver outcomes in patients diagnosed with cirrhosis at LaCardio hospital. We describe the demographic variables of our cohort and outcomes such as mortality, acute kidney injury, need for dialysis and hospital admission for acute heart failure in the post-transplant period up to one year of follow-up.

Materials and Methods

Retrospective cohort study. Patient with liver transplant at LaCardio hospital, in Bogotá, Colombia, between January 2005 and July 2021. Analysis of sociodemographic variables, comorbidities, echocardiography and intraoperative variables, with primary outcomes such as early graft dysfunction, acute kidney injury and intraoperative mortality. A classification and regression tree (CART) was performed.

Results

397 patients were analyzed, with 54.4% men. The median of age was 56 years and the most common etiology of cirrhosis was alcoholic. The most common comorbidities were hypertension (54%) and type 2 diabetes mellitus (24%). In 71% of patients, there was some degree of diastolic dysfunction and left ventricular hypertrophy (30.9%). The presence of graft dysfunction was present in up to 8% of patients and was associated with acute kidney injury (AKI) in 21%, requirement of multiple transfusions during surgery and renal replacement therapy with a mortality of 15% during study follow-up. In the CART model for mortality and graft dysfunction outcomes, it was related to the presence of BMI<19 or the combination of BMI between 19 and <24 with dialysis.

Conclusions

Echocardiographic variables, the presence of sarcopenia and the presence of AKI or requirement of renal replacement therapy were related to mortality and graft dysfunction outcomes.

Figure 1: Distribution of liver transplant patients and mortality during the observational period (Up to 1 year). We classified the risk groups by a regression tree. This method provides a predictive model of three profiles of risk: a body mass index (BMI) less than 19 and a BMI less than 24 with or without the requirement of dialysis.