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. 2025 Oct 7;14(19):7067.
doi: 10.3390/jcm14197067.

Outcomes in Asymptomatic Patients Undergoing Coronary Revascularization Before Liver Transplantation

Goyal Umadat  1 , Jennifer Lee  2 , Jordan C Ray  1 , Ryan M Chadha  3 , Yaohua Ma  4 , Hanna J Sledge  4 , Surakit Pungpapong  5 , Leslie E Janik  1 , Dilip Pillai  1 , Abdallah El Sabbagh  1 , Peter Pollak  1 , Shahyar M Gharacholou  1
Affiliations

Outcomes in Asymptomatic Patients Undergoing Coronary Revascularization Before Liver Transplantation

Goyal Umadat et al. J Clin Med. .

Abstract

Background: Coronary artery disease (CAD) is common among liver transplantation (LT) candidates, yet whether pre-transplant percutaneous coronary intervention (PCI) improves post-LT outcomes remains uncertain. Methods: We conducted a single-center, Institutional Review Board-approved cohort study of adults undergoing LT from 2005 to 2025. Asymptomatic candidates with significant stenosis on invasive angiography were included; prior coronary artery bypass grafting was excluded. The primary endpoint was major adverse cardiovascular events (MACE: myocardial infarction [MI], stroke/transient ischemic attack, new systolic dysfunction, post-LT coronary revascularization, or all-cause death). Results: Among 111 patients (median age 65 years; 84% male), 66 (59%) underwent PCI and 45 (41%) were managed medically. Over a median 32 months of follow-up, 61 patients (55%) experienced MACE. Composite MACE did not differ between PCI and non-PCI groups (52% vs. 60%, p = 0.40; log-rank p = 0.59). Fine-Gray modeling showed no association of PCI with MACE; independent predictors were prior MI (HR 1.81, 95% CI 1.01-3.24) and pre-transplant dialysis (HR 2.13, 95% CI 1.07-4.24). Major bleeding occurred in 7%. Matched and era-stratified analyses were concordant. Conclusions: In asymptomatic LT candidates with angiographically severe CAD, pre-LT PCI was not associated with a lower incidence of post-LT MACE.

Keywords: coronary artery disease; liver transplant; revascularization.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Univariate Cox Proportional Hazards Analysis of Overall MACE.
Figure 2
Figure 2
Multivariate Cox Proportional Hazards Analysis of Overall MACE. * = p-value < 0.05.
Figure 3
Figure 3
Probability of MACE by Revascularization Status.
Figure 4
Figure 4
Cumulative Incidence Function for MACE with Death as a Competing Outcome.
Figure 5
Figure 5
Fine-Gray Model of MACE with Death as the Competing Factor.
See this image and copyright information in PMC

References

    1. El Hadi H., Di Vincenzo A., Vettor R., Rossato M. Relationship between Heart Disease and Liver Disease: A Two-Way Street. Cells. 2020;9:567. doi: 10.3390/cells9030567. - DOI - PMC - PubMed
    1. Verrijken A., Francque S., Mertens I., Prawitt J., Caron S., Hubens G., Van Marck E., Staels B., Michielsen P., Van Gaal L. Prothrombotic factors in histologically proven nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2014;59:121–129. doi: 10.1002/hep.26510. - DOI - PubMed
    1. Daniel K.E., Eickhoff J., Lucey M.R. Why do patients die after a liver transplantation? Clin. Transpl. 2017;31:e12906. doi: 10.1111/ctr.12906. - DOI - PubMed
    1. Kashyap R., Jain A., Reyes J., Demetris A., Elmagd K., Dodson S., Marsh W., Madariaga V., Mazariegos G., Geller D., et al. Causes of death after liver transplantation in 4000 consecutive patients: 2 to 19 year follow-up. Transpl. Proc. 2001;33:1482–1483. doi: 10.1016/S0041-1345(00)02561-6. - DOI - PMC - PubMed
    1. Patel S.S., Lin F.P., Rodriguez V.A., Bhati C., John B.V., Pence T., Siddiqui M.B., Sima A.P., Abbate A., Reichman T., et al. The relationship between coronary artery disease and cardiovascular events early after liver transplantation. Liver Int. 2019;39:1363–1371. doi: 10.1111/liv.14092. - DOI - PMC - PubMed

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