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Published on: November 7, 2020
Long-Term Survival in Liver Transplant Patients With Coronary Artery Disease: A Multi-Institutional Study
Christopher L Wray1, Jennifer C Scovotti1, Jonathan Tobis2
1Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
Older liver transplant recipients have increased coronary artery disease (CAD). This study found obstructive CAD negatively impacts long-term survival after liver transplantation, contrary to earlier findings.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Liver transplant (LT) recipient age is increasing, leading to a higher prevalence of coronary artery disease (CAD).
- Long-term outcomes for LT recipients with CAD remain poorly understood.
- Previous research indicated similar early survival between LT recipients with and without treated CAD.
Purpose of the Study:
- To evaluate long-term post-transplant survival in liver transplant recipients with pre-existing coronary artery disease.
- To determine the impact of obstructive CAD on all-cause mortality after liver transplantation.
Main Methods:
- Retrospective analysis of 604 adult LT recipients who underwent pre-LT angiography.
- Data collected from 7 institutions between 1998 and 2010.
- Assessment of post-transplant survival based on the presence and severity of CAD.
Main Results:
- Obstructive CAD (≥50% stenosis) was identified in 24% of LT recipients.
- Patients with obstructive CAD had significantly higher mortality (adjusted HR: 1.39).
- Severe CAD (>70% stenosis) and prior revascularization were associated with increased mortality risk.
Conclusions:
- Long-term post-transplant survival in liver transplant recipients is adversely affected by underlying obstructive coronary artery disease.
- This finding contrasts with previous reports on early post-transplant survival.
- Obstructive CAD is a significant risk factor for long-term mortality in the LT population.
Background:
The age of liver transplant (LT) recipients continues to increase, and as a result, the prevalence of coronary artery disease (CAD) has risen. Long-term post-transplant outcomes in LT patients with CAD are poorly understood.
Objectives:
We previously demonstrated in a multi-institutional LT cohort that early post-transplant survival was similar between recipients with angiographically-proven, treated CAD and those with no CAD and nonobstructive CAD. We now present a follow-up study in this same cohort. Our objective is to determine long-term post-transplant survival in LT recipients with known pretransplant CAD. All-cause mortality is the primary outcome.
Methods:
We performed a retrospective analysis for post-transplant survival in 604 adult LT recipients who underwent angiography prior to LT at 7 institutions between 1998 and 2010.
Results:
Angiographically-proven obstructive CAD (≥50% stenosis) was present in 145 of 604 patients (24%). No CAD or nonobstructive CAD was found in 459 patients (76%). Mortality was higher in patients with CAD (adjusted HR: 1.39; CI: 1.06-1.82; P = 0.0159) than in those without CAD. Patients with CAD were further stratified by CAD severity and by pretransplant coronary revascularization. Mortality was higher in patients with severe CAD as defined by >70% vessel stenosis (adjusted HR: 1.63; CI: 1.19-2.22; P = 0.002) and in patients that underwent revascularization (adjusted HR: 1.62; 95% CI: 1.18-2.23, P = 0.003) than in those without CAD. Mean follow-up time was 87.6 ± 55.6 months (7.3 ± 4.6 years) for all patients.
Conclusions:
Contrary to our previous report, this investigation suggests that long-term post-transplant survival is adversely affected by underlying obstructive CAD.
