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Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation
Author(s) -
Yong Celina M.,
Sharma Madan,
Ochoa Victor,
Abnousi Freddy,
Roberts John,
Bass Nathan M.,
Niemann Claus U.,
Shiboski Stephen,
Prasad Megha,
Tavakol Mehdi,
Ports Thomas A.,
Gregoratos Gabriel,
Yeghiazarians Yerem,
Boyle Andrew J.
Publication year - 2010
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22152
Subject(s) - medicine , liver transplantation , coronary artery disease , cardiology , transplantation , cardiac catheterization , ejection fraction , stenosis , retrospective cohort study , liver disease , surgery , heart failure
The optimal preoperative cardiac evaluation strategy for patients with end‐stage liver disease (ESLD) undergoing liver transplantation remains unknown. Patients are frequently referred for cardiac catheterization, but the effects of coronary artery disease (CAD) on posttransplant mortality are also unknown. We sought to determine the contribution of CAD and multivessel CAD in particular to posttransplant mortality. We performed a retrospective study of ESLD patients undergoing cardiac catheterization before liver transplant surgery between August 1, 2004 and August 1, 2007 to determine the effects of CAD on outcomes after transplantation. Among 83 patients who underwent left heart catheterization, 47 underwent liver transplantation during the follow‐up period. Twenty‐one of all ESLD patients who underwent liver transplantation (45%) had CAD. Fifteen of the transplant patients with CAD (71%) had multivessel disease. Among transplant patients, the presence of multivessel CAD (versus no CAD) was predictive of mortality (27% versus 4%, P = 0.046), increased length of stay (22 versus 15 days, P = 0.050), and postoperative pressor requirements (27% versus 4%, P = 0.029). Interestingly, neither the presence of any CAD nor the severity of stenosis in any single coronary artery predicted mortality. Furthermore, none of the traditional clinical predictors (age, gender, diabetes, creatinine, ejection fraction, and Model for End‐Stage Liver Disease score) were predictive of mortality among transplant recipients. In conclusion, multivessel CAD is associated with higher mortality after liver transplantation when it is documented angiographically before transplantation, even in the absence of severe coronary artery stenosis. This study provides preliminary evidence showing that there may be significant prognostic value in coronary angiography as a part of the pretransplant workup. Liver Transpl 16:1242‐1248, 2010. © 2010 AASLD.