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Published on: November 7, 2020
Trends, Clinical Characteristics, and Outcomes of Percutaneous Coronary Intervention in Liver Transplant Recipients
Song Peng Ang1, Jia Ee Chia2, Jose Iglesias1
1Department of Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey, USA.
Insights
Liver transplant recipients (LTRs) undergoing percutaneous coronary intervention (PCI) had lower in-hospital mortality despite higher comorbidities. This suggests specialized care and survivor bias may contribute to better outcomes in this high-risk group.
Area of Science:
- Cardiology
- Transplant Surgery
- Health Services Research
Background:
- Liver transplant recipients (LTRs) have elevated cardiovascular risks due to immunosuppression and metabolic changes.
- Coronary artery disease (CAD) management in LTRs is understudied, especially post-transplant.
- Existing research primarily focuses on CAD in patients awaiting liver transplantation.
Purpose of the Study:
- To evaluate the outcomes of percutaneous coronary intervention (PCI) in liver transplant recipients (LTRs).
- To compare in-hospital mortality and complications between LTRs and non-transplant patients undergoing PCI.
- To identify trends in PCI hospitalizations among LTRs.
Main Methods:
- Retrospective cohort study utilizing the National Inpatient Sample database (2016-2021).
- Analysis of PCI hospitalizations in LTRs and non-transplant patients.
- Propensity score matching (1:3) to balance patient characteristics; primary outcome was in-hospital mortality.
Main Results:
- LTRs undergoing PCI had higher rates of diabetes and chronic kidney disease but lower rates of hyperlipidemia.
- Crude rates of acute kidney injury (AKI) and blood transfusions were higher in LTRs.
- After matching, LTRs showed significantly lower odds of in-hospital mortality and cardiogenic shock.
Conclusions:
- Despite increased comorbidities and complications, LTRs undergoing PCI experienced lower in-hospital mortality compared to non-transplant patients.
- Potential factors include survivor bias, intensive pre- and post-transplant care, and specialized management.
- Further research with detailed clinical data is needed to confirm these findings.
Background:
Coronary artery disease (CAD) poses a significant challenge for liver transplant recipients (LTRs) who face higher cardiovascular risks due to immunosuppressive therapies and metabolic changes. While extensive research has focused on CAD management in patients awaiting liver transplantation, data on the outcomes of percutaneous coronary intervention (PCI) in the post-transplant population remain limited.
Methods:
This retrospective cohort study used the National Inpatient Sample database (2016-2021) to evaluate PCI hospitalizations involving LTR and non-transplant patients. Propensity score matching (1:3) was applied to balance the covariates between the LTRs and non-transplant patients. The primary outcome was in-hospital mortality.
Results:
Among the 2 681 545 PCI hospitalizations, LTRs accounted for 0.1% (n = 2675). LTRs were more likely to have diabetes (60.56% vs. 41.36%) and chronic kidney disease (60.93% vs. 21.06%) but less likely to have hyperlipidemia (58.32% vs. 72.65%; all p < 0.001). The crude rates of AKI (32.34% vs. 16.07%; p < 0.001) and blood transfusion (5.61% vs. 2.76%; p = 0.0001) were higher in the LTRs. After matching, the LTRs were associated with lower odds of in-hospital mortality (OR, 0.55; 95% CI, 0.30-1.00; p = 0.05) and cardiogenic shock (OR, 0.46; 95% CI, 0.29-0.74; p = 0.001). PCI hospitalizations among LTRs increased over time, peaking in 2019 (116.6/100 000).
Conclusion:
Despite higher comorbidities and complication rates, LTRs undergoing PCI exhibited lower in-hospital mortality than non-transplant patients, likely reflecting survivor bias, rigorous pre- and post-transplant care, and specialized management. These preliminary findings highlight the need for further studies with detailed clinical data to validate the current findings.
