Preoperative aortic regurgitation and early graft survival in liver transplant recipients

Introduction Cardiovascular events are the leading cause of early mortality after Liver Transplantation (LT). LT candidates undergo Doppler echocardiogram as part of the cardiac assessment before waitlist registration. Aim To identify echocardiographic parameters able to predict early graft loss. Materials and Methods Retrospective bi-center (Policlinico Umberto I and Policlinico Gemelli, both in Rome) observational study (period 2005-2020) including adult patients transplanted with a diagnosis of liver cirrhosis, with or without hepatocellular carcinoma. Echocardiographic examinations performed in peripheral centers or over 12 months from LT were excluded. Multivariable logistic regression analyses were performed. Results 481 patients were included. The population was stratified according to degree of liver dysfunction: MELD 6-29 Group (n=421, 87.5%), and MELD ≥30 Group (n=60, 12.5%). 43 (8.9%) graft losses were reported within the first 90 days after LT; in 9 (1.9%) patients graft loss was caused by a technical issue (hepatic arterial thrombosis=6, severe bleeding=3). No case of graft loss was directly correlated with heart failure. Patients with MELD ≥30 had a smaller median left ventricular mass (P=0.03), smaller median left atrial diameter (P=0.03), higher median ejection fraction (P=0.004), lower percentage of patients with mitral (P<0.001) and tricuspidal regurgitation (P=0.002), and lower median sPAP (P=0.004).Aortic regurgitation was the only independent risk factor for graft loss (OR=2.58, 95%CI=1.12-5.93; P=0.03), and it's predictive value was confirmed in three sub-analysis: MELD ≥30 patients (OR=11.50, 95%CI=1.06-124.54; P=0.04), excluding surgical technique-related graft losses (OR=3.03; 95%CI=1.16-7.93; P=0.02), excluding the 8 (1.7%) cases of moderate aortic regurgitation OR=2.42 (95%CI=1.03-5.67; P=0.04). No relevant differences were observed when ejection fraction was estimated according to the presence or not of aortic regurgitation. Conclusions In LT patients, aortic regurgitation is an independent predictor of early graft survival, even in case of mild form and with a concomitant valid ejection fraction.