IDDF2021-ABS-0095 A meta-analysis and systematic review on the global prevalence, risk factors and outcomes of coronary artery disease in liver transplant recipients

Abstract

<h3>Background</h3> The changing demographics of waitlisted liver transplantation (LT) patients and shift in etiology of liver disease result in increasing prevalence of coronary artery disease (CAD), which can impact post-LT outcomes. This study aims to evaluate the prevalence of CAD among potential LT recipients, describe the risk factors of CAD and investigate the impact of pre-LT CAD on post-LT outcomes. <h3>Methods</h3> Two electronic databases, MEDLINE and EMBASE, were searched for articles describing the CAD in pre-LT patients. Articles that describe the prevalence, risk factors and outcomes of pre-LT patients diagnosed with CAD were included. Generalized linear mixed model (GLMM) and Clopper-Pearson intervals to stabilize the variance were used to tabulate the prevalence of CAD in pre-LT patients and outcomes post-LT. The prevalence of CAD in pre-LT patients was stratified across different regions and countries of varying income levels. Risk factors of CAD and outcomes were analyzed with regression or pairwise analysis. <h3>Results</h3> Total of 39 articles were included. The pooled prevalence of 15,880 patients from 34 studies diagnosed with CAD before LT was 15.88% (CI: 9.81% - 24.69%, IDDF2021-ABS-0095 Figure 1. Screening Method of CAD before Liver Transplant). LT candidates in high-income countries had markedly higher odds of CAD (OR: 10.5; CI: 8.12 – 13.7; p &lt; 0.0001) compared to patients in middle-income countries. Age, male, presence of diabetes, hypertension, hyperlipidemia, smoking, non-alcoholic steatohepatitis, hepatitis B and hepatocellular carcinoma were significantly associated with CAD. CAD diagnosis prior to LT was a significant risk factor for overall mortality (OR: 1.42; CI: 1.40 – 1.43; p = 0.0140) and cardiac-related mortality (OR: 1.18; CI: 1.10 – 1.27; p = 0.0347) post-LT. North America had the highest pooled prevalence of CAD in pre-LT patients at 23.61% (CI: 14.07% - 36.83%) amongst South America, Europe, Middle east, Asia and Oceania. 69% of the included studies utilized non-invasive stress tests and invasive coronary angiograms in their pre-LT cardiac assessment (IDDF2021-ABS-0095 Figure 2. Global Prevalence of CAD before Liver Transplant). <h3>Conclusions</h3> This meta-analysis and systematic review demonstrate the high prevalence of CAD in pre-LT patients, the associated risk factors and outcomes. More studies are required to determine the optimal screening methodology for CAD in pre-LT patients.