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Outcome of Liver Transplant Recipients With Revascularized Coronary Artery Disease: A Comparative Analysis With and Without Cardiovascular Risk Factors

Satapathy, Sanjaya K. MBBS, MD, DM; Vanatta, Jason M. MD; Helmick, Ryan A. MD; Flowers, Albert MD; Kedia, Satish K. PhD; Jiang, Yu PhD; Ali, Bilal MD; Eason, James MD; Nair, Satheesh P. MD; Ibebuogu, Uzoma N. MD

doi: 10.1097/TP.0000000000001647
Original Clinical Science-Liver

Background: Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). We aim to assess survival in LT recipients based on presence, severity, extent of CAD, and cardiac events within 90 days of LT.

Methods: Eighty-seven LT recipients with history of pre-LT angiogram (December 2005 to December 2012) were compared with 2 control groups without prior angiogram, 72 LT recipients matched for cardiovascular risk factors (control group I), and 119 consecutive LT recipients without any CV risk factors (control group II). CAD was assessed by (1) vessel score (≥50% reduction in luminal diameter), and (2) Extent score (Reardon scoring system).

Results: Of the 87 LT recipients (study group), 58 (66.7%) had none or less than 50% stenosis, 29 (33.3%) had obstructive CAD (≥50% stenosis), 7 (8%) with single-vessel disease, and 22 (25.3%) with multivessel disease. In the study group, irrespective of prerevascularization severity of CAD (P = 0.357), number of segments involved (0, 1-2, > 2 segments, P = 0.304) and extent of CAD based on Reardon score (0, 1-9, >10, P = 0.224), comparable posttransplant survival was noted. Overall, patient survival in the revascularized CAD group was comparable to angiogram group without obstructive CAD, and both control group I and control group II (P = 0.184, Log Rank). Postoperative cardiac events within 90 days of LT predicted poor survival in study group as well as control groups.

Conclusions: Severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. Early postoperative cardiac events are associated with inferior survival in LT recipients, irrespective of underlying CAD.

Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). The authors show that listing for LT after appropriate re-vascularization in patients deemed high risk for CAD will lead to comparable post-LT survival compared to those without obstructive CAD irrespective of underlying severity, or extent disease.

1 Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN.

2 Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN.

3 School of Public Health, University of Memphis, Memphis, TN.

4 Department of Cardiology, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN.

Received 13 February 2016. Revision received 11 December 2016.

Accepted 17 December 2016.

The authors declare no funding or conflicts of interest.

S.K.S., A.F., and U.N.I. designed the study. A.F., J.M.V., B.A., and S.K.S. collected the data. S.K.S. performed the statistical analysis. S.K.S., R.H., S.K.K., and Y.J. interpreted the data. U.N.I. reviewed all the angiogram findings independently. S.K.S. wrote the first draft with inputs from J.M.V., J.E., S.N., and U.N.I. R.H., B.A., S.K.K., and Y.J. helped revise the article. All authors contributed intellectually, participated in additional discussions, and revised the article, and approved the final version.

Correspondence: Sanjaya K. Satapathy, MBBS, MD, D.M., FACG, Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, 1211 Union Avenue, Suite 340, Memphis, TN 38104. (ssatapat@uthsc.edu).

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