Higher Mortality And Resource Utilization In Patients Undergoing Cardiac Transplantation Affected By Non-alcoholic Fatty Liver Disease, Nation-Wide Study

• Published in: Journal of cardiac failure Vol. 30; no. 1; pp. 292 - 293
• Main Authors: Khokhlov, Leonid, Hussain, Fatima, Ali, Mehnaaz, Mena, Angel, Aboelnasr, Amr, Rahima, Kenan, Mateo-Faxas, Sila, Eshghabadi, Amin, Hijazi, Mohamad, Kishore, Sindhu, Ghazi, Freidoon, Shemisa, Kamal, Kesari, Sateesh
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2024
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.419

Heart transplantation (HTx) is a treatment option for patients with end-stage heart failure (HF) who remain symptomatic despite optimal medical therapy. There is a growing number of patients undergoing HTx. Non-alcoholic fatty liver disease (NAFLD) is known to increase the risk of adverse outcomes. At this moment, there is limited scientific evidence of clinical outcomes in HTx patients affected by NAFLD. Therefore, we sought to investigate this population. We queried NIS between 2017-2020 for adult patients who were hospitalized for HTx and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay (LOS) and total hospital cost. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. p-value < 0.05 was significant. There were 11,795 hospitalizations for HTx, of which 1,215 (10.3%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 51.0 vs. 54.3 yrs; males 74% vs 71.5%; Caucasians 61.7% vs 58.4%; HF 94.6% vs 96.2%; LVAD 14.8% vs 19.1%, obesity 11.1% vs 12.5%; HLD 22.6% vs 37.1%; anemia 10% vs 15%, DM 24.2% vs 33.2%; AF 33.3% vs 40.2%; CKD 43.2% vs 45.3%, history of MI 4.1% vs 12.6%; stroke 6.5% vs 3.7%, COPD 5.7% vs 8.9%, respectively. NAFLD subgroup experienced complications with ACS 8.6% vs 3.1%, severe sepsis 24.6% vs 5%, ARF 44% vs 22.5%. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). Patients undergoing heart transplantation with co-existent NAFLD demonstrated significantly worse clinical outcomes and higher resource utilization. They were younger and less comorbid overall. NAFLD is associated with increased rates of acute complications, GIB, cardiac and respiratory failure. Detection and appropriate management of NAFLD in patients undergoing HTx would improve clinical results. More research is needed to describe long-term outcomes.