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The predictors of post-transplant coronary events among liver transplant recipients

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Abstract

Background/purpose

Cardiac morbidities can occur during the peri- and post-liver transplant (LT) period, affecting the long-term survival. The purpose of this study was to identify the potential factors that predict a coronary event post-transplantation.

Methods

Medical records of patients who underwent liver transplantation at Johns Hopkins Hospital between 2009 and 2013 were retrospectively reviewed. We looked at pre-liver transplant cardiac risk factors and the diagnostic tests utilized for coronary artery disease screening. Patients with and without post-liver transplant coronary events were compared.

Results

There were a total of 146 patients with a mean age at LT of 55.3 years. The prevalence of hypertension, tobacco use and diabetes within the patient population was 61.6 % (n = 90), 39 % (n = 57) and 37.6 % (n = 55), respectively. There were 29 deaths and 30 coronary events over a median follow-up period of 1.75 years. Age at the time of liver transplant was predictive of coronary event (OR 1.11, CI 1.01–1.20). The 1-year survival in patients with a coronary event was 47 versus 94 % in patients without a coronary event. The combined use of a dobutamine stress echocardiogram and coronary artery calcium score predicted a coronary event with a sensitivity of 62.5 % and specificity of 66.7 %.

Conclusion

In conclusion, LT recipients with cardiac events had limited survival as compared to the cohort without coronary events. Identification of such patients with noninvasive screening may provide a practical alternative to an invasive cardiac workup. Further improvement in screening strategies may minimize the liver transplant cardiac morbidity.

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Abbreviations

CAD:

Coronary artery disease

CA:

Coronary artery calcium score

CABG:

Coronary artery bypass grafting

DSE:

Dobutamine stress echocardiogram

ESLD:

End-stage liver disease

ECG:

Electrocardiogram

HR:

Hazard ratio

INR:

International normalized ratio

IQR:

Interquartile range

LT:

Liver transplant

LVEF:

Left ventricular ejection fraction

MELD:

Model of end-stage liver disease score

NASH:

Non-alcoholic steatohepatitis

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

RVSP:

Right ventricular systolic pressure

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Acknowledgement

The authors would like to thank Frances Morello, PA-C, for her editorial help in the preparation of this manuscript. This project was partially supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through grant no. 101872.

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Correspondence to Ahmet Gurakar.

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Conflict of interest

Mohammad U. Malik, Stuart D. Russell, Aliaksei Pustavoitau, Matthews Chacko, Arif M. Cosar, Carol B. Thompson, Panagiotis Trilianos, Nabil N. Dagher, Andrew M. Cameron and Ahmet Gurakar have no conflicts of interest for this study.

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Malik, M.U., Russell, S.D., Pustavoitau, A. et al. The predictors of post-transplant coronary events among liver transplant recipients. Hepatol Int 10, 974–982 (2016). https://doi.org/10.1007/s12072-016-9742-5

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  • DOI: https://doi.org/10.1007/s12072-016-9742-5

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