Work

Major adverse cardiovascular events after liver transplantation: a population cohort analysis of English transplant centres

Year: 2026

Type: article

Abstract: Background: Major adverse cardiovascular events (MACE) are common early after liver transplantation (LT) as reported in the United States, but incidence is not well described in a European cohort. With lower MACE rates reported after kidney transplantation in the United Kingdom versus the United States, it is important to determine if a similar incongruity exists after LT. Methods: In this large retrospective, population cohort study, we studied all LT procedures performed in England between 1st April 2002 and 31st March 2023 (n = 10,213). MACE data was obtained from Hospital Episode Statistics, an administration data warehouse for any hospitalization to English NHS hospital, and defined as any of the following: myocardial infarction, stroke, unstable angina, heart failure, any coronary revascularization procedure and any cardiovascular-defined death. Findings: MACE-related 1-year mortality was low at 0.1% (n = 11). Overall, MACE occurred in 268 (2.6%) LT recipients within the first year after LT, of which 125 (1.2%) occurred within the first month. The commonest observed MACE was stroke (n = 129, 1.3%), followed by myocardial infarction (n = 89, 0.9%). After adjustment, MACE within the first year was associated with increased risk for long-term all-cause mortality (Hazard Ratio 1.37, 95% CI 1.05-1.79, p = 0.021). In a competing risk regression model, with non-cardiac death a competing risk, the following were independently associated with increased risk of MACE after LT: increasing age, male sex, diabetes, and higher Charlson co-morbidity score. Interpretation: MACE and cardiovascular death are uncommon within the first-year post LT in England. However, liver transplant recipients with non-fatal MACE have inferior long-term survival. Further work is warranted to determine the best strategy to mitigate cardiac risk stratification for LT candidates and evidence-based strategies to mitigate cardiovascular risk after LT must be encouraged. Funding: Nothing to disclose.

Source: EClinicalMedicine

DOI: 10.1016/j.eclinm.2025.103734