Abstract Body (Do not enter title and authors here):
Background: Postoperative left ventricular systolic dysfunction (LVSD) in patients undergoing orthotopic liver transplant (OLT) is a known phenomenon, however, risk factors are not fully delineated.

Methods: We performed a single-center retrospective analysis of all patients undergoing OLT from 2015 to 2022 and identified cases in which post-OLT left ventricular ejection fraction (LVEF) was less than or equal to 45% within one year. Controls were identified using 1:1 propensity matching on the variables of age, sex, pre-OLT Model for End-Stage Liver Disease (MELD) score, cirrhosis etiology, and pre-transplant LVEF. Baseline demographic, laboratory and echocardiographic parameters were collected. Univariate logistic regression with odds ratios (OR) and 95% confidence intervals (CI) were calculated for each predictor variable.

Results: Of all patients who underwent OLT (n=956), 66 (6.9%) developed LVSD, with 41 cases (62.1%) occurring within the first 30 days post-OLT. Mean length of stay was not significantly different (79 ± 52 versus 63 ± 53 days, p = 0.086), though patients with LVSD had increased ICU length of stay (56 ± 43 versus 33 ± 27 days, p= 0.002). Preoperative diagnosis of obstructive coronary artery disease (CAD) (OR 8.6, CI 2.3 – 56.5) and chronic obstructive pulmonary disease (COPD) (OR 7.7, CI 1.3 - 146), as well as pre-operative mineralocorticoid receptor antagonist use (OR 2.5, CI 1.3 – 5.2) were independent predictors of LVSD. Of the echocardiographic parameters measured, none were significantly associated with the development of LVSD, though increased left ventricular (LV) size showed a trend towards being predictive (OR 2.71 CI 0.940 – 8.89 p = 0.077). See Figure 1 for Forest Plots of all variables analyzed.

Conclusions: After OLT, LVSD occurs in a significant minority of patients most commonly within 30 days post-transplant and is associated with increased ICU length of stay. Baseline obstructive CAD and COPD were associated with the development of LVSD after OLT. Although no basic echocardiographic parameters were predictive of post-OLT LVSD, LV size showed a trend towards significance and signals a potential avenue for future research into more advanced echocardiographic predictors.