Background: Cardiovascular diseases are among the most frequent causes of patient death after liver transplantation. Due to recent improvements in survival of liver transplant, there is only few data available analyzing the prevalence and management of chronic heart failure (CHF) in liver recipients.
Purpose: The aim of this retrospective clinical study was to estimate the etiology, frequency and management of chronic heart failure before and after liver transplantation. A total of 115 patients who had undergone successful liver transplantation between 2010 and 2016 at the Scientific Research Institute-Regional Clinical Hospital ?1 were studied.
Results: Mean age was 53 ± 13 years and 66 (57.4 %) were men. Chronic heart failure was verified in 20.9% of patients before liver transplantation, among them NYHA class I - 37.5%, NYHA class II- 50%, NYHA class III - 12.5%. Chronic heart failure was considered to develop due to arterial hypertension in 58.3% of patients, due to coronary heart disease (CHD) in 37.5%, among them six patients had a combination of CHD and arterial hypertension. One case of anteroseptal myocardial infarction (CHF - NYHA class II), 3 new cases of CHF were registered as a complication of arterial hypertension 6 months after liver transplantation. Over 1 year, we observed elevation of new-onset CHF (13%) compared with preoperative, among them NYHA class I had 63.3%, NYHA class II - 36.4% (arterial hypertension and CHF - 90.9%, coronary heart disease and CHF - 9.1%).
Beta-blockers were administrated in 75%, among them 88.9% received nonselective agents - propranolol, 11.1% - bisoprolol before liver transplantation. 24 patients without cardiac pathology and CHF were assigned to propranolol, which is probably associated with portal hypertension in patients before liver transplantation. Retrospective analysis revealed that only 7.1% of recipients with CHF received beta-blockers after 6 months and 7.7% after one year transplantation. ACE inhibitors were received in 16.7% of patients before surgery, after 6 months and after one year - 3.6% and 10.3%, respectively.
Conclusions. The development of chronic heart failure arises after transplantation. We suggest that it is vitally important to manage transplant-related CHF effectively by paying our physicians’ attention to administration of ACE inhibitors and beta-blockers.