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NASH, HCV cirrhosis predict coronary artery disease in liver transplantation

Patients who underwent liver transplantation evaluation had a high prevalence of coronary artery disease, especially those with nonalcoholic steatohepatitis-related cirrhosis, hepatitis C-related cirrhosis and alcoholic cirrhosis, according to a recently published study.

“An integral component of the liver transplant evaluation (LTE) is coronary artery disease (CAD) assessment as surgical morbidity and mortality can be as high as 81% and 50%, respectively, in patients with significant CAD undergoing LT,” Samarth S. Patel, MD, from the Virginia Commonwealth University, and colleagues wrote. “We conducted the following study to describe the distribution of CAD noted on per-protocol coronary angiography in patients undergoing LTE, risk factors associated with CAD and complications associated with coronary angiography.”

Patel and colleagues prospectively collected data on 288 patients who underwent LTE at Virginia Commonwealth University between Jan. 1, 2011, and Dec. 31, 2014. The indications for LTE included HCV-related decompensated cirrhosis (47.8%), NASH (23.2%), alcoholic cirrhosis (19.7%), primary sclerosing cholangitis (2.6%), primary biliary cholangitis (2.6%), autoimmune hepatitis (1.3%), hepatitis B (1.3%) or other (1.3%).

Eighty-four patients presented with CAD, with the highest prevalence among patients with NASH-related cirrhosis (52.8%), followed by HCV-related cirrhosis (39.4%) and alcoholic cirrhosis (20%).

Similarly, patients with NASH-related cirrhosis had the highest prevalence of nonobstructive (22.6%) and obstructive CAD (30.2%) vs. rates in HCV-related cirrhosis (nonobstructive, 20.2%; obstructive, 11.1%) and rates in alcoholic cirrhosis (nonobstructive, 8.9%; obstructive, 19.3%).

The prevalence of single-vessel CAD (15.1%) and 3-vessel CAD (9.4%) was significantly higher among patients with NASH compared with HCV-related cirrhosis (single-vessel, 4.6%; 3-vessel, 1%) and alcoholic cirrhosis (single-vessel, 6.6%; 3-vessel, 0%; P = .001).

The researchers observed the following risk factors associated with the presence of CAD: type 2 diabetes (OR = 2.31; 95% CI, 1.316-4.055), dyslipidemia (OR = 1.96; 95% CI, 1.069-3.592) and hypertension (OR = 2.15; 95% CI, 1.236-3.737). While NASH was the only etiology in the entire cohort correlated with CAD (OR = 2.42; 95% CI, 1.287-4.551), HCV correlated with CAD in a subset analysis of patients without NASH (OR = 2.458; 95% CI, 1.197-5.049).

Type 2 diabetes (OR = 2.363; 95% CI, 1.202-4.644), dyslipidemia (OR = 2.089; 95% CI, 1.022-4.27), current or prior history of hypertension (OR = 2.2; 95% CI, 1.135-4.265) and NASH (OR = 3.121; 95% CI, 1.332-5.321) remained independent predictors of significant CAD after adjusting for age, sex, BMI and smoking and family history.

Six patients experienced complications from coronary angiography, including bleeding in three patients, two patients admitted postprocedure with worsening renal function, and two patients admitted postprocedure with sepsis. However, none of these cases correlated with the patients’ clinical or biochemical profiles.

“The optimal algorithm for assessing patients with decompensated cirrhosis for CAD during LTE is unknown due to poorly defined prevalence and risk factors for CAD in this population. A major limitation of the published literature results from lack of per protocol coronary angiographies, thus introducing an inherent sampling bias,” the researchers wrote. “The current study narrows this gap in defining the distribution and risk factors associated with CAD using per protocol coronary angiography according to underlying etiology of primary liver disease.” – by Talitha Bennett

Disclosure: Healio.com/Hepatology was unable to determine the authors’ relevant financial disclosures at the time of publication.