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Coronary Interventions before Liver Transplantation Might Not Avert Postoperative Cardiovascular Events
Insights
Coronary interventions before liver transplantation do not improve survival for patients with severe coronary artery disease. Cardiac mortality remains high even after percutaneous coronary intervention or bypass grafting in these high-risk liver transplant recipients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Severe ischemic heart disease is a concern for patients undergoing orthotopic liver transplantation (OLT).
- Pre-transplant interventions like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are sometimes used, but evidence for improved outcomes is limited.
Purpose of the Study:
- To evaluate the impact of pre-transplant PCI and CABG on mortality in OLT patients with varying degrees of coronary artery disease.
Main Methods:
- Retrospective review of 2,010 OLT patients from 2000-2010.
- Analysis included 51 patients with coronary angiography within 6 months of OLT, categorized by disease severity (mild, moderate, severe).
- Comparison of all-cause and cardiac-cause mortality rates between intervention and non-intervention groups.
Main Results:
- A significant difference in cardiac deaths was observed (P <0.001), with 50% of patients undergoing PCI or CABG dying from cardiac causes.
- No cardiac deaths occurred in patients who did not undergo these interventions.
- All-cause mortality did not differ significantly between groups (P=0.624).
Conclusions:
- Pre-transplant coronary interventions do not significantly reduce mortality in OLT patients with severe coronary artery disease.
- High cardiac mortality persists despite PCI or CABG in this population.
- Further research is needed to optimize management strategies for cardiac disease in liver transplant candidates.
Abstract:
Percutaneous coronary intervention and coronary artery bypass grafting may be performed before orthotopic liver transplantation (OLT) to try to improve the condition of patients who have severe ischemic heart disease. However, data supporting improved outcomes are lacking. We reviewed the medical records of 2,010 patients who underwent OLT at our hospital from 2000 through 2010. The 51 patients who underwent coronary artery angiography within 6 months of transplantation were included in this study: 28 had mild coronary artery disease, 10 had moderate disease, and 13 had severe disease. We compared all-cause and cardiac-cause mortality rates. We found a significant difference in cardiac deaths between the groups (P <0.001), but none in all-cause death (P=0.624). Of the 10 patients who had moderate coronary artery disease, one underwent pre-transplant coronary artery bypass grafting. Of 13 patients with severe disease, 3 underwent percutaneous coronary intervention, and 6 underwent coronary artery bypass grafting. Overall, 50% of patients who underwent either intervention died of cardiac-related causes, whereas no patient died of a cardiac-related cause after undergoing neither intervention (P <0.0001). We conclude that, despite coronary intervention, mortality rates remain high in OLT patients who have severe coronary artery disease.
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