title: The impact of coronary artery disease on outcomes after liver transplantation.
abstract: OBJECTIVE
  The aim of this study is to assess the impact of obstructive coronary artery disease (CAD) on outcomes after liver transplantation.
  
  
  BACKGROUND
  Patients considered for liver transplantation are at an increased risk for CAD. Obstructive CAD is a contraindication for liver transplantation at most centres. However, the association between severity of CAD and liver transplantation outcomes remains poorly characterized.
  
  
  METHODS
  We retrospectively reviewed 386 consecutive liver transplantations performed between January 2001 and December 2005 at Northwestern Memorial Hospital (NMH). A comparative analysis was conducted for a national cohort (n = 23 820) from the United Network for Organ Sharing database. Outcome measures included patient and graft survival, rates of acute myocardial infarction and heart failure.
  
  
  RESULTS
  Patient survival remained similar irrespective of CAD severity or cardiovascular risk index (CRI) in the NMH cohort. The CRI closely correlated with the presence of CAD in the NMH cohort [CRI 0, odds ratio (OR) 0.125, 95% confidence interval (95% CI) 0.02-0.61, P = 0.01; CRI 1, OR 1 reference; CRI ≥2, OR 2.28, 95% CI 1.09-4.75, P = 0.02]. In the national cohort using Cox regression, high (≥2) CRI (reference 0, hazard ratio 1.376, 95% CI 1.271-1.488, P < 0.0001) predicted patient mortality and exceeded established risk factors, including Hepatitis C virus (HCV) (hazard ratio 1.321, 95% CI 1.242-1.403, P < 0.0001), hepatocellular carcinoma (HCC) (hazard ratio 1.27, 95% CI 1.181-1.370, P < 0.0001) and diabetes (hazard ratio 1.241, 95% CI 1.160-1.326, P < 0.0001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: aComprehensive Transplant Center, Northwestern Medicine, Chicago, Illinois, USA bNorthwestern Univeristy Transplant Outcomes Research Collaborative, Northwestern Medicine, Chicago, Illinois, USA cUT Transplant Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA dDepartment of Preventive Medicine, Northwestern Medicine, Chicago, Illinois, USA eDepartment of Anesthesia, Northwestern Medicine, Chicago, Illinois, USA fDepartment of Medicine, Division of Cardiology gDepartment of Medicine, Division of Gastroenterology and Hepatology hCenter for Cardiovascular Innovation, Northwestern Medicine, Chicago, Illinois, USA.
authors.forename: Anton I
authors.initials: AI
authors.lastname: Skaro
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Gallon
authors.forename: Vadim
authors.initials: V
authors.lastname: Lyuksemburg
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Jay
authors.forename: Lihui
authors.initials: L
authors.lastname: Zhao
authors.forename: Daniela P
authors.initials: DP
authors.lastname: Ladner
authors.forename: Lisa B
authors.initials: LB
authors.lastname: VanWagner
authors.forename: Andre M
authors.initials: AM
authors.lastname: De Wolf
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors