Successful Percutaneous Coronary Stenting in End-Stage Liver Disease Patients Awaiting Liver Transplantation

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Coronary artery disease (CAD) significantly increases risks for patients undergoing orthotopic liver transplantation (OLT).
• End-stage liver disease (ESLD) patients often present with multiple comorbidities, including CAD, complicating surgical candidacy.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous coronary intervention (PCI) in high-risk ESLD patients prior to OLT.
• To assess the impact of preoperative PCI on major adverse cardiac events (MACE) and 90-day post-OLT outcomes.

Main Methods:

• Retrospective analysis of six high-risk ESLD patients who underwent PCI with bare metal stents.
• Patients had advanced disease: high MELD-Na scores, thrombocytopenia, and elevated INR.
• Modified antiplatelet regimens were used post-PCI.

Main Results:

• No mortality or MACE occurred within 90 days of OLT in the studied cohort.
• All six patients tolerated stent implantation and subsequent OLT.
• The intervention facilitated listing for OLT in these complex patients.

Conclusions:

• Preoperative PCI with bare metal stents is a feasible strategy for high-risk ESLD patients with CAD.
• This intervention may improve OLT candidacy and lead to favorable post-transplant outcomes.
• Careful patient selection and modified antiplatelet therapy are crucial for success.