The impact of coronary artery disease on outcomes after liver transplantation
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Published on: November 7, 2020
Anton I Skaro1, Lorenzo G Gallon, Vadim Lyuksemburg
1aComprehensive Transplant Center, Northwestern Medicine, Chicago, Illinois, USA bNorthwestern Univeristy Transplant Outcomes Research Collaborative, Northwestern Medicine, Chicago, Illinois, USA cUT Transplant Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA dDepartment of Preventive Medicine, Northwestern Medicine, Chicago, Illinois, USA eDepartment of Anesthesia, Northwestern Medicine, Chicago, Illinois, USA fDepartment of Medicine, Division of Cardiology gDepartment of Medicine, Division of Gastroenterology and Hepatology hCenter for Cardiovascular Innovation, Northwestern Medicine, Chicago, Illinois, USA.
Insights
Liver transplantation outcomes are not significantly impacted by coronary artery disease (CAD) severity. Appropriately treated CAD should not contraindicate liver transplantation, as risks for cardiac events and mortality are not prohibitive.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Patients undergoing liver transplantation face elevated risks of coronary artery disease (CAD).
- Obstructive CAD is typically a contraindication for liver transplantation, but its impact on outcomes is not well-understood.
Purpose of the Study:
- To evaluate the effect of obstructive coronary artery disease (CAD) on liver transplantation outcomes.
- To determine if CAD severity influences patient and graft survival post-transplantation.
Main Methods:
- Retrospective analysis of 386 liver transplantations at Northwestern Memorial Hospital (2001-2005).
- Comparative analysis with a national cohort of 23,820 liver transplantations from the United Network for Organ Sharing database.
- Outcome measures included patient/graft survival, myocardial infarction, and heart failure rates.
Main Results:
- Patient survival was similar across different CAD severities and cardiovascular risk index (CRI) levels in the NMH cohort.
- In a national cohort, a high CRI (≥2) significantly predicted patient mortality, surpassing risk factors like Hepatitis C virus (HCV), hepatocellular carcinoma (HCC), and diabetes.
- The CRI demonstrated a strong correlation with the presence of CAD in the NMH cohort.
Conclusions:
- Liver transplantation in patients with CAD does not carry a prohibitive risk for cardiac events or mortality.
- Treated coronary artery disease should not be an absolute contraindication for liver transplantation.
Aims:
The aim of this study is to assess the impact of obstructive coronary artery disease (CAD) on outcomes after liver transplantation.
Background:
Patients considered for liver transplantation are at an increased risk for CAD. Obstructive CAD is a contraindication for liver transplantation at most centres. However, the association between severity of CAD and liver transplantation outcomes remains poorly characterized.
Methods:
We retrospectively reviewed 386 consecutive liver transplantations performed between January 2001 and December 2005 at Northwestern Memorial Hospital (NMH). A comparative analysis was conducted for a national cohort (n = 23 820) from the United Network for Organ Sharing database. Outcome measures included patient and graft survival, rates of acute myocardial infarction and heart failure.
Results:
Patient survival remained similar irrespective of CAD severity or cardiovascular risk index (CRI) in the NMH cohort. The CRI closely correlated with the presence of CAD in the NMH cohort [CRI 0, odds ratio (OR) 0.125, 95% confidence interval (95% CI) 0.02-0.61, P = 0.01; CRI 1, OR 1 reference; CRI ≥2, OR 2.28, 95% CI 1.09-4.75, P = 0.02]. In the national cohort using Cox regression, high (≥2) CRI (reference 0, hazard ratio 1.376, 95% CI 1.271-1.488, P < 0.0001) predicted patient mortality and exceeded established risk factors, including Hepatitis C virus (HCV) (hazard ratio 1.321, 95% CI 1.242-1.403, P < 0.0001), hepatocellular carcinoma (HCC) (hazard ratio 1.27, 95% CI 1.181-1.370, P < 0.0001) and diabetes (hazard ratio 1.241, 95% CI 1.160-1.326, P < 0.0001).
Conclusion:
Liver transplantation in patients with CAD is not associated with prohibitive risk for cardiac events and patient mortality. Appropriately treated CAD should therefore not represent a contraindication to liver transplantation.
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