The impact of coronary artery disease on outcomes after liver transplantation

Skaro, Anton I.; Gallon, Lorenzo; Lyuksemburg, Vadim; Jay, Colleen L.; Zhao, Lihui; Ladner, Daniela P.; VanWagner, Lisa B.; Wolf, André M. De; Flaherty, James; Levitsky, Josh; Abécassis, Michaël; Gheorghiade, Mihai

doi:10.2459/jcm.0000000000000207

Cited by 47 publications

(55 citation statements)

References 42 publications

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“…The incidence of systolic HF after OLT reported in our study is similar to that reported by others . Qureshi et al reported an incidence of 7% among 970 patients after a median follow‐up of 5 years, a quarter among who developed HF within a week of OLT.…”

Section: Discussionsupporting

confidence: 90%

“…Controls were matched for variables that may independently influence post‐OLT cardiac function, specifically age, gender, and MELD score. A higher MELD score has been shown to be associated with systolic HF after OLT in some studies . As we were looking at transplant recipients over a decade, we also included year of OLT to our matching criteria to account for any change in practice that might have occurred during this period.…”

Section: Methodsmentioning

confidence: 99%

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Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

Sonny

Govindarajan

Jaber

et al. 2018

Clinical Transplantation

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Although most patients presenting for liver transplantation have normal left ventricular function, some develop left ventricular failure after transplantation. The primary objective of our study was to determine the predictors of systolic heart failure (HF) occurring immediately after liver transplantation. Its etiology, prospects of recovery, and factors associated with nonrecovery were also studied. Liver transplantations performed at our institution from January 2006 to February 2015 were evaluated using prospectively collected institutional registries. Patients with echocardiographically documented decline in ejection fraction to <45% within 6 months after liver transplantation were identified. Four controls were chosen per case: matched for age, gender, transplant year, and model for end-stage liver disease score. Conditional multivariable logistic regression was used for primary analysis and nonparametric tests for comparison between groups. In a cohort of 1284 adult patients, 45 cases and 180 controls were identified. Diastolic dysfunction (DD) was an independent predictor (OR 5.26, 95% CI 1.03-28.57, P = .04) of systolic HF in multivariable analysis. Stress-induced cardiomyopathy was the most common etiology. Left ventricular function recovered in 21 patients. Pretransplant DD decreased the chances of recovery (P = .05). In conclusion, patients with pretransplant DD need close post-transplant follow-up for timely identification of HF.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

Sonny

Govindarajan

Jaber

et al. 2018

Clinical Transplantation

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“…13-16 Multi-vessel CAD (versus no CAD) has been associated with increased mortality and postoperative hemodynamic instability even in the absence of severe stenosis, 17 however, recent data has shown that severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. 8,18 …”

Section: Coronary Artery Diseasementioning

confidence: 99%

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

VanWagner

Harinstein

Runo

et al. 2018

American Journal of Transplantation

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122

181

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Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis, thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. Therefore, this review, assembled by a group of multidisciplinary experts in the field and endorsed by the American Society of Transplantation Liver and Intestine and Thoracic and Critical Care Communities of Practice, provides a critical assessment of the diagnosis of cardiac and pulmonary vascular disease and interventions aimed at managing these conditions in LT candidates. Key points and practice-based recommendations for the diagnosis and management of cardiac and pulmonary vascular disease in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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“…Uma justificativa para diferença de resultados pode residir no fato de que nossos pacientes que apresentavam lesão obstrutiva importante foram submetidos previamente a angioplastia coronária havendo, portanto, redução potencial do risco o que não se deu em outros estudos (6,8) . Pesquisa revisando 386 casos consecutivos de transplante hepático constatou também que a mortalidade permaneceu similar independentemente do grau de coronariopatia obstrutiva concluindo que a realização de transplante hepático em pacientes com doença arterial coronária, não se associa com risco proibitivo de eventos cardíacos e mortalidade, uma vez apropriadamente tratados preoperatoriamente (13) .…”

Section: Discussionunclassified

Impacto Da Doença Arterial Coronária Na Mortalidade Tardia De Hepatopatas Crônicos Em Programa De Transplante Hepático

Godoy

Sanmiguel²,

Silva³

et al. 2015

ACS

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ResumoIntrodução: A doença arterial coronariana apresenta prevalência significativa em portadores de insuficiência hepática avançada e relaciona-se às complicações cardiovasculares e eventos isquêmicos no perioperatório do transplante hepático, aumentando a morbimortalidade e podendo, inclusive, contraindicar o transplante hepático. Objetivo: Comparar a mortalidade em longo prazo de pacientes portadores de insuficiência hepática avançada com doença arterial coronariana em relação aos sem doença arterial coronariana e também com relação à realização ou não de angioplastia coronária antes do transplante hepático. Casuística e Métodos: Análise de 154 pacientes com mais de 40 anos de idade, que aguardavam na fila de transplante hepático em um serviço de referência e que foram submetidos a cateterismo cardíaco como parte da avaliação pré-operatória. Resultados: Dos 154 pacientes submetidos a cateterismo, 40 (26,0%) apresentaram graus variáveis de obstrução coronária (de leve a importante) na avaliação cardiológica preparatória. Do total de casos, 75 chegaram ao transplante hepático, sendo que 13 (17,3%) eram coronariopatas. Houve predomínio de coronariopatia no grupo não transplantado (p = 0,0183; Teste Exato de Fisher, bicaudal). A análise comparativa com auxílio de curvas de sobrevivência de Kaplan-Meier para livres de óbito mostrou que a melhsor taxa de sobrevivência, 53,8±13,8% ao final de 3418 dias com sobrevida média de 1881,7 dias (IC95% 891,6 a 2871,7 dias), aconteceu no grupo de transplantados do fígado e portadores de Coronariopatia, enquanto que a pior taxa de sobrevivência, 11,7±10,5% ao final de 2295 dias com sobrevida mediana de 565 dias (IC95% 321 a 995 dias) e sobrevida média de 852,8 dias (IC95% 432,9 a 1272,8 dias), ocorreu no grupo de não transplantados e portadores de coronariopatia. Conclusão: Detectou-se que a presença de coronariopatia obstrutiva, independentemente do grau de obstrução presente, não é empecilho à realização de transplante hepático em hepatopatas crônicos uma vez que a melhor taxa de sobrevivência aconteceu justamente no grupo de transplantados do fígado portadores de coronariopatia.Descritores: Insuficiência Hepática; Transplante de Fígado; Indicadores de Morbimortalidade. AbstractIntroduction: Coronary artery disease has a significant prevalence in patients with advanced liver failure causing complications related to cardiovascular events and/or myocardial ischemia, increasing morbidity and mortality. The presence of coronary artery disease may also contraindicate liver transplantation. Objective: To compare the long-term mortality of patients with advanced liver failure with coronary artery disease compared to those without coronary artery disease. Patients and Methods: Analysis of 154 patients over 40 years age, who was waiting in line for liver transplantation in a reference service and who underwent cardiac catheterization as part of pre-operatory evaluation. Results Of the 154 patient who underwent catheterization, 40 patients (26.0%) had some degree of coronary vessel ob...

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The impact of coronary artery disease on outcomes after liver transplantation

Abstract: Liver transplantation in patients with CAD is not associated with prohibitive risk for cardiac events and patient mortality. Appropriately treated CAD should therefore not represent a contraindication to liver transplantation.

Cited by 47 publications

References 42 publications

Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

Systolic heart failure after liver transplantation: Incidence, predictors, and outcome

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

Impacto Da Doença Arterial Coronária Na Mortalidade Tardia De Hepatopatas Crônicos Em Programa De Transplante Hepático

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