Abstract 11805: Hidden Hazards: Unraveling Risk Factors for New-Onset Acute Heart Failure in Liver Transplant Recipients

Introduction: Heart failure with reduced ejection fraction (HFrEF) following liver transplantation (LT) is associated with increased morbidity and mortality. Early identification and optimization of risk factors associated with development of heart failure in LT recipients could improve cardiac and liver transplant outcomes.

Hypothesis: The study's primary objectives were to ascertain the incidence of new-onset HFrEF post-liver transplant, identify the associated risk factors and understand their clinical outcomes. We hypothesized that certain demographic and clinical factors may predispose liver transplant recipients to develop new-onset HFrEF.

Methods: Our retrospective cohort study included 568 liver transplant recipients at our center. Patients were categorized based on whether or not they developed new-onset HFrEF post LT We utilized descriptive statistics, chi-square tests, and logistic regression analyses to investigate potential associations between patient demographics, clinical risk factors and the development of new HFrEF .

Results: The incidence of acute heart failure post-transplant was 8% (n=43). Within this group, 51% had HFrEF (LVEF<40%), 37% HFmrEF (LVEF 40-49%),12% HF with preserved EF. LVEF was significantly lower in the new-onset HF group [40(30-45) vs 60(55-65), p<0.001]. Median time to HF onset was 25 days. Coronary artery disease (OR 2.53, 95% CI 1.01-6.35, p=0.04) and malignancy history (OR 2.35, 95% CI 1.15-4.81, p=0.02) were significant predictors of new onset HFrEF. New onset HFrEF was associated with higher 180-day mortality (14% vs 6%, OR 2.57, 95% CI 1.00-6.56, p=0.048).

Conclusions: Coronary artery disease and history of malignancy were identified as risk factors for new-onset HFrEF post-LT. Additional research is needed to better understand the impact of CAD and malignancy on cardiac and liver transplant outcomes that may result in improved patient care.