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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
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Coronary artery disease in decompensated patients undergoing liver transplantation evaluation

Samarth S Patel1, Eiman Nabi1, Luis Guzman2

  • 1Divisions of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Richmond, VA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|January 13, 2018
PubMed

Insights

Coronary artery disease (CAD) is common in liver transplant candidates. Nonalcoholic steatohepatitis-related cirrhosis shows the highest CAD prevalence, highlighting the need for cardiac evaluation before liver transplantation.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Medicine

Background:

  • Coronary artery disease (CAD) significantly impacts morbidity and mortality in liver transplantation (LT) patients.
  • Existing literature on CAD in LT candidates suffers from sampling bias and nondefinitive assessments.
  • Comprehensive evaluation of CAD is crucial for optimizing outcomes in patients undergoing liver transplantation evaluation (LTE).

Purpose of the Study:

  • To determine the prevalence of CAD in patients undergoing LTE using per-protocol coronary angiography.
  • To investigate the relationship between the etiology of liver disease and the prevalence and severity of CAD.
  • To assess the safety and complication rates of coronary angiography in this patient population.

Main Methods:

  • Prospective data collection from 228 patients undergoing coronary angiography as part of LTE between 2011 and 2014.
  • Coronary angiography was performed in patients aged ≥50 years or with known CAD risk factors.
  • CAD defined as any stenosis; single-vessel disease (SVD) and triple-vessel disease (TVD) defined as ≥70% stenosis in 1 or 3 major coronary arteries, respectively.

Main Results:

  • Overall CAD prevalence was 36.8%, with the highest rate (52.8%) observed in nonalcoholic steatohepatitis (NASH) patients with cirrhosis.
  • NASH patients exhibited higher prevalence of both SVD (15.1%) and TVD (9.4%) compared to hepatitis C virus (HCV) and alcoholic cirrhosis.
  • After adjusting for traditional risk factors, NASH remained the only etiology significantly associated with CAD.

Conclusions:

  • Patients evaluated for LTE have a high prevalence of CAD, with significant variation based on the underlying liver disease etiology.
  • Nonalcoholic steatohepatitis-related cirrhosis is associated with a notably higher prevalence and severity of CAD.
  • Diagnostic coronary angiography and percutaneous coronary intervention demonstrated low complication rates (2.6%) in this cohort.

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