Effectively Screening for Coronary Artery Disease in Patients Undergoing Orthotopic Liver Transplant Evaluation

Abstract

Coronary artery disease (CAD) is prevalent in patients with end-stage liver disease and associated with poor outcomes when undergoing orthotopic liver transplantation (OLT); however, noninvasive screening for CAD in this population is less sensitive. In an attempt to identify redundancy, we reviewed our experience among patients undergoing CAD screening as part of their OLT evaluation between May 2009 and February 2014. Demographic, clinical, and procedural characteristics were analyzed. Of the total number of screened patients (n = 132), initial screening was more common via stress testing (n = 100; 75.8%) than coronary angiography (n = 32; 24.2%). Most with initial stress testing underwent angiography (n = 52; 39.4%). Among those undergoing angiography, CAD was common (n = 31; 23.5%). Across the entire cohort the number of traditional risk factors was linearly associated with CAD, and those with two or more risk factors were found to have CAD by angiography 50% of the time (OR 1.92; CI 1.07–3.44, p = 0.026). Our data supports that CAD is prevalent among pre-OLT patients, especially among those with 2 or more risk factors. Moreover, we identified a lack of uniformity in practice and the need for evidence-based and standardized screening protocols.

The Pre-Transplant Profile of Cardiovascular Risk Factors and Its Impact on Long-Term Mortality After Liver Transplantation

“…In a retrospective review by Lee et al [ 12 ], moderate stenosis was present in 23.5% of patients and 5.3% had severe stenosis. A study by Tiukinhoy-Laing et al [ 13 ] showed the prevalence of moderate-to-severe CAD to be 24%.…”

Cardiac diseases among liver transplant candidates

“…Coronary artery disease (CAD) has been shown to decrease 1‐year post‐LT survival by 50% . The number of traditional risk factors appears to have a linear relationship with angiographically detected CAD, and survival is worse with 2 or more coronary risk factors …”

Coronary artery bypass graft combined with liver transplantation in patients with advanced alcoholic liver cirrhosis: A case report

“…Patients often exhibit coronary heart disease when waiting for liver transplantation and some patients cannot receive coronary stenting; therefore, coronary artery bypass grafting is the only effective treatment (6)(7)(8)(9). Coronary artery bypass grafting is contraindicated in end-stage liver disease due to symptoms of coagulation dysfunction, refractory hypoalbuminemia, pleural effusion, edema of the lower extremities, hepatic encephalopathy, hypersplenism, leukopenia, thrombocytopenia and gastrointestinal bleeding (10,11).…”