Left Ventricular Diastolic Dysfunction Defined Using the 2016 ASE Criteria and Mortality after a Liver Transplant in Patients with End-Stage Liver Disease: A Systematic Review

Abstract

Left ventricular diastolic dysfunction (LVDD) is a hallmark of cirrhotic cardiomyopathy and has been linked to a poorer quality of life and worse outcomes in patients with end-stage liver disease. Its impact on survival after a liver transplant (LT) is not known, especially when using current diagnostic criteria to define LVDD. We conducted a systematic review and meta-analysis of the current published literature on mortality after a LT in patients with LVDD. We searched for articles in PubMed, Scopus, EMBASE, Web of Science, and the COCHRANE Central database. We included cohort studies that compared post-transplant outcomes between cirrhotic patients with and without LVDD. Our primary outcome of interest was all-cause mortality after a LT in relation to the presence of LVDD per the 2016 American Society of Echocardiography criteria. A total of 1029 articles were screened during the selection process. Two studies included in the meta-analysis showed no significant difference in mortality, but there was high heterogeneity. A narrative review of other studies that classified diastolic function (DD) using different criteria was also performed, revealing an association with worse outcomes in these patients. High-quality prospective studies using current criteria are needed to confirm these findings.