Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation.

Doo-Hwan Kim,Tae-Yong Ha,Wooil Kim,Joon-Won Kang,Young-Kug Kim,Hyun-Jung Koo,Dong-Hyun Yang,Sung-Gyu Lee,Shin Hwang

doi:10.3390/jcm10143132

Abstract

Computed tomographic coronary angiography (CTCA) has prognostic value for early major adverse cardiac events (MACEs) after liver transplantation. However, the association between CTCA and long-term MACEs in liver transplant (LT) recipients remains unknown. We evaluated the association between CTCA and long-term MACEs within 5 years after living donor liver transplantation (LDLT). A total of 628 LDLT recipients who underwent CTCA were analyzed between 2010 and 2012. MACEs were investigated within 5 years after LDLT. The factors associated with long-term MACEs in transplant recipients were evaluated. Only 48 (7.6%) patients developed MACEs. In the Fine and Gray competing risk regression, a coronary artery calcium score (CACS) of >400 combined with obstructive coronary artery disease (CAD) (subdistribution hazard ratio: 5.01, 95% confidence interval: 2.37–10.58, p < 0.001), age (1.05, 1.01–1.10, p = 0.018), diabetes mellitus (2.43, 1.37–4.29, p = 0.002), dyslipidemia (2.45, 1.23–4.70, p = 0.023), and creatinine (1.19, 1.08–1.30, p < 0.001) were independently associated with long-term MACEs. CACS (>400) combined with obstructive CAD may be associated with MACEs within 5 years after LDLT, suggesting the importance of preoperative noninvasive CTCA in LT recipients. The evaluation of coronary artery stenosis on CTCA combined with CACS may have a prognostic value for long-term MACEs in LT recipients.

Highlights

Liver transplant (LT) recipients are at a high risk of developing cardiovascular diseases (CVDs), which have emerged as a leading cause of post-transplant morbidity and mortality [1]
Several known risk factors for CVD such as hyperlipidemia, hypertension, and diabetes are masked by end-stage liver disease, making it difficult to identify LT recipients who are at the highest risk of CVD [4]
In terms of the American Heart Association (AHA)/ACCF risk factors, significant difference was observed in the incidence of diabetes, hypertension, and dyslipidemia between the major adverse cardiac events (MACEs) and non-MACE

Summary

Introduction

Liver transplant (LT) recipients are at a high risk of developing cardiovascular diseases (CVDs), which have emerged as a leading cause of post-transplant morbidity and mortality [1]. Identifying the risk factors for CVD is crucial for cardiac risk stratification, and proper preoperative cardiac examinations should be mandated [2,3]. Several known risk factors for CVD such as hyperlipidemia, hypertension, and diabetes are masked by end-stage liver disease, making it difficult to identify LT recipients who are at the highest risk of CVD [4]. A myocardial perfusion scan or a dobutamine stress echocardiography is recommended for LT recipients with several known risk factors for coronary artery diseases (CADs) [5], the usefulness of these examinations is limited because of their relatively low sensitivity in detecting CAD in LT recipients [6].

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