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Coronary Atherosclerosis in Liver Transplant Recipients and Population Controls: A Nationwide Study Using
Andreas Dehlbæk Knudsen1, Jørgen Tobias Kühl2, Nicolai Aagaard Schultz3
1Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Liver transplant recipients show significantly higher rates of coronary atherosclerosis compared to the general population. This highlights the need for proactive cardiovascular risk assessment and preventive strategies in this patient group.
Area of Science:
- Cardiology
- Transplant Hepatology
- Radiology
Background:
- Coronary atherosclerosis prevalence and severity in liver transplant (LTx) recipients are not well-understood due to reliance on limited imaging data.
- Prior studies often used clinically indicated or retrospective imaging, lacking standardized research protocols.
Purpose of the Study:
- To investigate the prevalence and severity of coronary atherosclerosis in LTx recipients.
- To compare coronary atherosclerosis in LTx recipients versus matched control subjects using standardized coronary CT angiography.
Main Methods:
- A cross-sectional study matched 205 LTx recipients (from the DACOLT study) with 1,025 population controls (from the Copenhagen General Population Study) by age and sex.
- Standardized questionnaires, physical examinations, and coronary CT angiography were performed.
- Coronary atherosclerosis was classified as any, obstructive (≥50% stenosis), or extensive (>5 segments); logistic regressions adjusted for cardiovascular risk factors.
Main Results:
- LTx recipients exhibited higher prevalence of any (63% vs 46%), obstructive (18% vs 10%), and obstructive-extensive (13% vs 6%) coronary atherosclerosis compared to controls.
- After adjustment, LTx recipients had significantly increased odds for any (OR: 2.19), obstructive (OR: 2.73), and obstructive-extensive (OR: 3.90) coronary atherosclerosis.
- LTx recipients with coronary atherosclerosis were more likely to have high-risk plaque (OR: 2.10).
Conclusions:
- Liver transplant recipients demonstrate significantly higher prevalence and severity of coronary atherosclerosis than general population controls, even after accounting for traditional risk factors.
- Enhanced cardiovascular risk assessment and preventive measures are crucial for LTx recipients.
- Findings stem from the Danish Comorbidity in Liver Transplant Recipients Study (DACOLT; NCT04777032).
Background:
Prevalence and severity of coronary atherosclerosis in liver transplant (LTx) recipients remain poorly characterized because prior work has relied on clinically indicated imaging or retrospective studies.
Objectives:
The purpose of this study was to determine the prevalence and severity of coronary atherosclerosis in LTx recipients compared with control subjects using protocolized research-coronary CT angiography in both LTx recipients and control subjects.
Methods:
In this cross-sectional study, LTx recipients aged ≥40 years from the DACOLT (Danish Comorbidity in Liver Transplant Recipients) study were matched 1:5 by age and sex with population controls from the Copenhagen General Population Study. Questionnaires, physical examinations, and coronary computed tomography angiography were performed uniformly in all participants. Coronary atherosclerosis was categorized as any, obstructive (≥50% stenosis), and extensive (>5 coronary segments) coronary atherosclerosis. Logistic regressions were adjusted for age, sex, hypertension, diabetes, dyslipidemia, smoking, and obesity.
Results:
We included 205 LTx recipients and 1,025 population control subjects. Median age was 56 years, and 40% were women. SCORE2 (Systematic COronary Risk Evaluation 2) risk did not differ significantly between LTx recipients and control subjects (P = 0.20). LTx recipients had significantly higher prevalence of any coronary atherosclerosis (63% vs 46%; P < 0.0001), obstructive coronary atherosclerosis (18% vs 10%; P < 0.0001), and obstructive-extensive coronary atherosclerosis (13% vs 6%; P < 0.0001), than control subjects. After adjusting for confounders, living with a transplanted liver remained associated with higher odds of any coronary atherosclerosis (OR: 2.19; 95% CI: 1.48-3.27), obstructive coronary atherosclerosis (OR: 2.73; 95% CI: 1.43-5.16), and obstructive-extensive coronary atherosclerosis (OR: 3.90; 95% CI: 1.76-8.55). Among individuals with any coronary atherosclerosis, LTx recipients had higher odds of having high-risk plaque than population control subjects (OR: 2.10; 95% CI: 1.29-3.45).
Conclusions:
LTx recipients had a significantly higher prevalence and severity of coronary atherosclerosis compared with matched general population control subjects, after adjusting for traditional cardiovascular risk factors. Conscious cardiovascular risk assessment and preventive strategies should be considered in this patient group. (The Danish Comorbidity in Liver Transplant Recipients Study [DACOLT]; NCT04777032).
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