This article is more than 5 years old. Information may no longer be current.

Coronary artery disease increases mortality, cardiovascular event risk in liver transplant recipients

LAS VEGAS — Patients with coronary artery disease who undergo liver transplantation are at increased risk for cardiovascular events and death following the procedure, according to data presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.

Researchers categorized the extent of coronary artery disease (CAD) in 474 patients who received orthotopic liver transplantation (OLT) between January2000 and June 2008 by reviewing pre-transplant cardiac catheterization reports. Patients’ coronary disease severity was classified as mild (<50%), moderate (50%-70%) or severe (>70%), and the number of diseased vessels was noted. Post-transplant incidence of major adverse cardiac events (MACE), defined as death, CAD, cardiac arrest, acute coronary syndrome, cerebovascular accidents, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), was observed during a median follow-up of 6.3 years.

Mazen Albeldawi

“Cardiovascular disease has emerged as the leading cause of on-graft related deaths,” researcher Mazen Albeldawi, MD, a fellow at the Digestive Disease Institute, Cleveland Clinic, told Healio.com. “The importance of coronary artery disease in end-stage liver disease is now being recognized. Currently, there are no specific guidelines for the management of CAD in pre-OLT patients.”

Most patients with single- or multi-vessel disease at transplant had mild or moderate CAD, while patients with severe disease often underwent pre-transplant PCI or CABG. Patients with no pre-transplant disease were significantly less likely to develop MACE post-transplant than patients with either single- or multi-vessel disease (P=.008). No significant difference in MACE risk was observed according to the number of diseased vessels (HR=1.6, 0.18-14.1 for multivessel compared with single-vessel), but risk trended toward significance when patients with single-vessel disease were compared with those without CAD (HR=6.1, 0.79-48.0) (95% CI for both).

At least one cardiovascular event occurred in 28% of patients with CAD within 5 years of transplant. Among those with CAD who underwent revascularization before transplant, investigators observed a significantly increased risk both for MACE (HR=7.6, 3.0-19.3) and cardiac-related mortality (HR=5.5, 1.4-22.6) within 5 years of the procedure. All-cause mortality risk also was significantly higher within this group (HR=2.4, 1.0-5.8) (95% CI for all).

“The most important finding of our study was that coronary revascularization carries an increased risk of post OLT CV events and mortality,” Albeldawi said. “Based on our study results, we need to rethink our current clinical paradigm of deeming patients to be low vascular risk after coronary revascularization. On the contrary, coronary revascularization (ie, PCI or CABG) prior to liver transplantation carries an increased risk of morbidity and mortality.”

For more information:

Albeldawi M. #35: Predicting Cardiovascular Events after Liver Transplantation: Does Degree of Coronary Vessel Disease Play a Role? Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.