Predicting Cardiovascular Events after Liver Transplantation: Does Degree of Coronary Vessel Disease Play a Role?: ACG/AstraZeneca Fellow Award

Abstract

Purpose: Recipients of orthotopic liver transplantation (OLT) are at increased risk of developing cardiovascular complications. Identifying candidates at highest risk of postoperative complications is a cornerstone of optimizing outcomes and utility. There is ongoing debate in regards to pre-transplant candidates deemed to be low vascular risk, with mild to moderate coronary artery disease (CAD) and their risk of post-OLT cardiac complications in comparison to candidates without CAD. We sought to investigate whether the number of diseased vessels (none vs. single or multi-vessel) or extent of coronary disease on angiography predicts risk of major adverse cardiac events (MACE) post transplant. Methods: Cardiac catheterization reports of all adult patients who underwent OLT at our institution from January 2000 to June 2008 were reviewed. Extent of coronary disease was categorized as mild < 50%, moderate 50-70%, or severe >70%. MACE was defined as acute coronary syndrome (ACS), coronary artery disease (CAD), cerebrovascular accident (CVA), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), cardiac arrest and death. Results: 474 adult patients (mean age 56.1 + 9.8 years, 69% males) who underwent OLT with a median follow up of 6.3 years were studied. The majority of patients transplanted with single or multi-vessel had mild-to-moderate disease and those with severe disease either had PCI or CABG prior to OLT. Pre-transplant history of multi-vessel disease in comparison to no CAD [9.7 (3.0, 30.9); p < 0.001] was predictive of MACE post-LT. We found no significant difference between single- vs. multi-vessel disease [1.6 (0.18, 14.1); p = 0.69], although there was a trend toward significance when comparing single vessel disease vs. no CAD [6.1 (0.79, 48.0); p = 0.083]. Conclusion: In summary, candidates who were deemed low-vascular risk and subsequently underwent OLT, are actually at higher risk than previously surmised. Those with multi-vessel disease (low to moderate severity), and those who received CABG for severe disease, are almost 10 times more likely to experience a post-transplant cardiac event than those without coronary disease.Figure: No Caption available.