Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease

Table 1 Patient characteristics with nonalcoholic fatty liver disease listed for liver transplant

Variable	Total (n = 265)	Transplanted (n = 197)		Not transplanted due to death or clinical deterioration (n = 68)		P value
Demographics
Age (yr)	63.1 [57.4, 67.2]	197	62.8 [56.6, 66.7]	68	64.1 [59.6, 68.5]	0.060a
Sex		197		68		0.42b
Female	137 (51.7)		99 (50.3)		38 (55.9)
Male	128 (48.3)		98 (49.7)		30 (44.1)
Model for End-Stage Liver Disease	17.0 [13.0, 24.0]	197	17.0 [13.0, 24.0]	68	18 [12.0, 24.5]	0.44a
Body mass index (kg/m2)	31.6 [28.3, 37.2]	197	32.2 [28.3, 36.8]	68	31.3 [28.2, 38.6]	0.79a
Comorbid Conditions
Renal replacement therapy	32 (12.1)	197	24 (12.2)	68	8 (11.8)	0.93b
Hypertension	152 (57.4)	197	113 (57.4)	68	39 (57.4)	0.99b
Obstructive sleep apnea	62 (23.4)	197	40 (20.3)	68	22 (32.4)	0.043b
Cardiac disease
Atrial fibrillation/Atrial flutter	8 (3.0)	197	5 (2.5)	67	3 (4.5)	0.42c
Heart failure	18 (6.9)	194	10 (5.2)	68	8 (11.8)	0.091c
Left ventricular ejection fraction	65.0 [61.0, 70.0]	196	66.0 [61.5, 70.5]	67	65.0 [61.0, 70.0]	0.80a
Estimated right ventricular systolic pressure	31.0 [25.0, 36.0]	142	30.0 [25.0, 35.0]	48	34.0 [26.5, 38.5]	0.012a
Aortic stenosis	8 (3.0)	197	7 (3.6)	68	1 (1.5)	0.68c
Aortic insufficiency	2 (0.75)	197	1 (0.51)	68	1 (1.5)	0.45c
Mitral regurgitation	4 (1.5)	197	3 (1.5)	68	1 (1.5)	0.99c
Tricuspid regurgitation	8 (3.0)	197	4 (2.0)	68	4 (5.9)	0.21b
CAD		197		68		0.12b
No significant CAD	196 (74.0)		152 (77.2)		44 (64.7)
Mild or Moderate CAD	45 (17.0)		30 (15.2)		15 (22.1)
Severe CAD	24 (9.1)		15 (7.6)		9 (13.2)
History of myocardial infarction	12 (4.5)	197	7 (3.6)	68	5 (7.4)	0.19c
History of coronary artery stenting	13 (4.9)	197	8 (4.1)	68	5 (7.4)	0.33c
History of coronary artery bypass grafting	11 (4.2)	197	7 (3.6)	68	4 (5.9)	0.48c
Lab values
Hemoglobin A1c		125		46		0.37b
< 5.6	59 (34.5)		47 (37.6)		12 (26.1)
5.6-6.5	62 (36.3)		43 (34.4)		19 (41.3)
> 6.5	50 (29.2)		35 (28.0)		15 (32.6)
High-density lipoprotein		188		63		0.31b
≥ 50	75 (29.9)		53 (28.2)		22 (34.9)
< 50	176 (70.1)		135 (71.8)		41 (65.1)
Triglycerides		190		65		0.37c
≤ 150	240 (94.1)		177 (93.2)		63 (96.9)
> 150	15 (5.9)		13 (6.8)		2 (3.1)

^aWilcoxon Rank Sum test.

^bPearson's chi-square test.

^cFisher's Exact test. Statistics presented as Median [P25, P75] and n (column %). CAD: Coronary artery disease.

Table 2 Univariate analysis on time to development of death/clinical deterioration prior to liver transplant

Variable	n	Events	Cox univariate hazard ratio (95%CI)	P value
Age	265	68 (26%)	1.018 (0.985, 1.053)	0.28
Sex
Female	137	38 (28%)	-
Male	128	30 (23%)	0.84 (0.52, 1.37)	0.49
Model for End-Stage Liver Disease	265	68 (26%)	1.18 (1.14, 1.23)	< 0.001
Body mass index	265	68 (26%)	0.975 (0.941, 1.011)	0.17
Renal replacement therapy
No	233	60 (26%)	-
Yes	32	8 (25%)	3.20 (1.49, 6.88)	0.003
Hypertension
No	113	29 (26%)	-
Yes	152	39 (26%)	1.15 (0.71, 1.88)	0.57
Obstructive sleep apnea
No	203	46 (23%)	-
Yes	62	22 (35%)	1.10 (0.66, 1.85)	0.72
Atrial fibrillation/Atrial flutter
No	256	64 (25%)	-
Yes	8	3 (38%)	2.97 (0.92, 9.61)	0.069
Heart failure				.
No	244	60 (25%)	-
Yes	18	8 (44%)	1.81 (0.86, 3.82)	0.12
Left ventricular ejection fraction	263	67 (25%)	0.99 (0.96, 1.03)	0.69
Estimated right ventricular systolic pressure	190	48 (25%)	1.026 (0.997, 1.055)	0.075
Aortic stenosis
No	257	67 (26%)	-
Yes	8	1 (13%)	0.95 (0.13, 6.86)	0.96
Aortic insufficiency
No	263	67 (25%)	-
Yes	2	1 (50%)	1.38 (0.19, 10.04)	0.75
Mitral regurgitation
No	261	67 (26%)	-
Yes	4	1 (25%)	2.92 (0.40, 21.48)	0.29
Tricuspid regurgitation
No	257	64 (25%)	-
Yes	8	4 (50%)	3.50 (1.26, 9.72)	0.016
CAD
No significant CAD	196	44 (22%)	-
Mild or Moderate CAD	45	15 (33%)	2.06 (1.14, 3.74)	0.017
Severe CAD	24	9 (38%)	2.43 (1.17, 5.05)	0.017
History of myocardial infarction
No	253	63 (25%)	-
Yes	12	5 (42%)	2.29 (0.92, 5.74)	0.076
History of coronary artery stenting
No	252	63 (25%)	-
Yes	13	5 (38%)	1.86 (0.74, 4.66)	0.19
History of coronary artery bypass grafting
No	254	64 (25%)	-
Yes	11	4 (36%)	2.03 (0.73, 5.65)	0.17
Hemoglobin A1c
< 5.6	59	12 (20%)	-	-
5.6-6.5	62	19 (31%)	1.11 (0.53, 2.32)	0.79
> 6.5	50	15 (30%)	0.80 (0.37, 1.76)	0.58
High-density lipoprotein
≥ 50	75	22 (29%)	-
< 50	176	41 (23%)	1.18 (0.69, 2.01)	0.54
Triglycerides
≤ 150	240	63 (26%)	-
> 150	15	2 (13%)	0.49 (0.12, 2.00)	0.32

CAD: Coronary artery disease.

Table 3 Multivariable model on failure to survive to liver transplant

Variable	Hazard ratio	95%CI	P value
Age	1.008	0.973-1.044	0.655
Sex: Male vs Female	1.026	0.592-1.777	0.927
Model for End-Stage Liver Disease	1.188	1.139-1.239	< 0.001
Mild or Moderate CAD vs No significant CAD	2.013	1.078-3.759	0.029
Severe CAD vs No significant CAD	2.096	0.968-4.538	0.060
Observations	265

CAD: Coronary artery disease.