The predictors of post-transplant coronary events among liver transplant recipients.
OBJECTIVE
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 %.


CONCLUSIONS
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.
Department of Gastroenterology/Hepatology, The Johns Hopkins School of Medicine, Rutland Avenue, Ross Research Building, Suite #918, Baltimore, MD, 21205, USA.
Mohammad U
MU
Malik
Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Stuart D
SD
Russell
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Aliaksei
A
Pustavoitau
Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Matthews
M
Chacko
Department of Gastroenterology/Hepatology, The Johns Hopkins School of Medicine, Rutland Avenue, Ross Research Building, Suite #918, Baltimore, MD, 21205, USA.
Arif M
AM
Cosar
The Johns Hopkins Bloomberg School of Public Health, Biostatistics Center, Baltimore, MD, USA.
Carol B
CB
Thompson
Department of Gastroenterology/Hepatology, The Johns Hopkins School of Medicine, Rutland Avenue, Ross Research Building, Suite #918, Baltimore, MD, 21205, USA.
Panagiotis
P
Trilianos
Department of Surgery/Liver Transplant, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Nabil N
NN
Dagher
Department of Surgery/Liver Transplant, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Andrew M
AM
Cameron
Department of Gastroenterology/Hepatology, The Johns Hopkins School of Medicine, Rutland Avenue, Ross Research Building, Suite #918, Baltimore, MD, 21205, USA. aguraka1@jhmi.edu.
Ahmet
A
Gurakar
D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D066027:Transplant Recipients
Cardiac disease; Cardiac risk factors; Coronary artery disease; Coronary event; Liver disease; Liver transplant