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Outcome of Liver Transplant Recipients With Revascularized Coronary Artery Disease: A Comparative Analysis With and
Sanjaya K Satapathy1, Jason M Vanatta, Ryan A Helmick
11 Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN. 2 Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN. 3 School of Public Health, University of Memphis, Memphis, TN. 4 Department of Cardiology, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN.
Insights
Coronary artery disease (CAD) does not impact liver transplant (LT) survival if revascularized. However, early postoperative cardiac events are linked to poorer survival in LT recipients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) poses a significant challenge in liver transplantation (LT) evaluations.
- Assessing the impact of CAD on post-LT survival is crucial for patient management.
Purpose of the Study:
- To evaluate survival rates in liver transplant recipients based on the presence, severity, and extent of coronary artery disease.
- To determine the influence of cardiac events within 90 days post-LT on patient survival.
Main Methods:
- A study group of 87 LT recipients with pre-LT angiograms was compared to two control groups.
- CAD was assessed using vessel and Reardon scoring systems.
- Survival analysis was performed comparing groups with varying degrees of CAD and control cohorts.
Main Results:
- Obstructive CAD (≥50% stenosis) was present in 33.3% of the study group, with 25.3% having multivessel disease.
- No significant difference in post-LT survival was observed based on CAD severity, extent, or number of involved segments, provided revascularization was performed.
- Patient survival in the revascularized CAD group was comparable to controls without obstructive CAD.
Conclusions:
- Appropriate revascularization negates the negative impact of CAD severity or extent on post-LT survival.
- Early postoperative cardiac events are independent predictors of inferior survival in LT recipients.
Background:
Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). We aim to assess survival in LT recipients based on presence, severity, extent of CAD, and cardiac events within 90 days of LT.
Methods:
Eighty-seven LT recipients with history of pre-LT angiogram (December 2005 to December 2012) were compared with 2 control groups without prior angiogram, 72 LT recipients matched for cardiovascular risk factors (control group I), and 119 consecutive LT recipients without any CV risk factors (control group II). CAD was assessed by (1) vessel score (≥50% reduction in luminal diameter), and (2) Extent score (Reardon scoring system).
Results:
Of the 87 LT recipients (study group), 58 (66.7%) had none or less than 50% stenosis, 29 (33.3%) had obstructive CAD (≥50% stenosis), 7 (8%) with single-vessel disease, and 22 (25.3%) with multivessel disease. In the study group, irrespective of prerevascularization severity of CAD (P = 0.357), number of segments involved (0, 1-2, > 2 segments, P = 0.304) and extent of CAD based on Reardon score (0, 1-9, >10, P = 0.224), comparable posttransplant survival was noted. Overall, patient survival in the revascularized CAD group was comparable to angiogram group without obstructive CAD, and both control group I and control group II (P = 0.184, Log Rank). Postoperative cardiac events within 90 days of LT predicted poor survival in study group as well as control groups.
Conclusions:
Severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. Early postoperative cardiac events are associated with inferior survival in LT recipients, irrespective of underlying CAD.
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