Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 1;107(4):933-940.
doi: 10.1097/TP.0000000000004402. Epub 2022 Nov 14.

Outcomes of Liver Transplantation in Patients With Preexisting Coronary Artery Disease

Emily Reznicek  1 , Kazunari Sasaki  2 , Bryce Montane  1 , Ariel Sims  1 , Jonathan Beard  1 , Maan Fares  3 , Vikram Sharma  2 , Jacek Cywinski  4 , Christiano Quintini  5 , Federico N Aucejo  6 , Bijan Eghtesad  6 , Charles M Miller  5 , K V Narayanan Menon  6
Affiliations

Outcomes of Liver Transplantation in Patients With Preexisting Coronary Artery Disease

Emily Reznicek et al. Transplantation. .

Abstract

Background: Advances in surgical and medical technology over the years has made liver transplantation possible for older and higher risk patients. Despite rigorous preoperative cardiac testing, cardiovascular events remain a major cause of death after orthotopic liver transplantation (OLT). However, there are little data on the outcomes of OLT in patients with preexisting coronary artery disease (CAD). This study aimed to compare all-cause and cardiovascular mortality of patients with and without history of CAD undergoing OLT.

Methods: Six hundred ninety-three adult patients with cirrhosis underwent liver transplantation between July 2013 and December 2018 (female n = 243, male n = 450; median age 59).

Results: During the study period of 5 y (median follow-up, 24.1 mo), 92 of 693 patients (13.3%) died. All-cause mortality in the CAD group was significantly higher than in the non-CAD group (26.7% versus 9.6%; P <0.01). Cardiovascular events accounted for 52.5% of deaths (n = 21) in patients with CAD compared with 36.5% (n = 19) in non-CAD patients. At 6 mo, patients with combined nonalcoholic steatohepatitis (NASH)/CAD had significantly worse survival than those with CAD or NASH alone ( P <0.01). After 6 mo, patients with CAD alone had similar survival to those with combined NASH/CAD.

Conclusions: Patients with preexisting CAD before liver transplantation are at higher risk of death from any cause, specifically cardiovascular-related death. This risk increases with coexisting NASH. The presence of NASH and CAD at the time of liver transplant should prompt the initiation of aggressive risk factor modification for patients with CAD.

PubMed Disclaimer

Conflict of interest statement

The authors declare no funding or conflicts of interest.

References

    1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137:67–492.
    1. Harinstein ME, Flaherty JD, Ansari AH, et al. Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates. Am J Transplant. 2008;8:1523–1528.
    1. Plotkin JS, Scott VL, Pinna A, et al. Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. Liver Transpl Surg. 1996;2:426–430.
    1. Petrowsky H, Rana A, Kaldas FM, et al. Liver transplantation in highest acuity recipients: identifying factors to avoid futility. Ann Surg. 2014;259:1186–1194.
    1. Diedrich DA, Findlay JY, Harrison BA, et al. Influence of coronary artery disease on outcomes after liver transplantation. Transplant Proc. 2008;40:3554–3557.