Aim: The aim of this study is to assess the risk factors for coronary artery disease (CAD) in patients undergoing orthotopic liver transplantation (OLT), and to evaluate the outcomes of patients accepted for OLT with CAD.

Methods: Data from 164 OLT recipients between April 2008 and December 2011 were retrospectively reviewed; recipients with multi-organ transplantation other than liver/kidney (n=7) were excluded. Demographic information, clinical characteristics and post OLT complications of those who had presence of CAD based on left heart catheterization(LHC) pre-OLT were compared to those who did not (n=129). Endpoints were allograft and patient survival. Kaplan Meier, Log rank, Chi square and Fisher’s exact tests were used for analyses.

Results: Mean patient age was 56 years (range, 21-75), 98 (62%) were male, 103 (66%) were white, and 82 (52%) had HCV. At OLT, mean biological MELD was 24±12. 28/164 patients had CAD on LHC: 19 mild (<50% stenosis), 7 moderate (50-70% stenosis), and 2 severe (50-70% stenosis). 11/28 patients had a single coronary vessel involved, and 17/28 had more than one coronary vessel involved. Recipients with CAD were more likely to be males [25 (89%) vs 73 (57%), p=0.001], older [median age 62.1± 6.6 vs 54.3 ±9.2, p≤0.001], and showed a higher incidence of history of diabetes mellitus pre-OLT [16 (57%) vs 43 (33%), p=0.02] as compared to who had no CAD (OR=2.7; 95% confidence CI, 1.2-6.1). Both groups exhibited low incidence of cardiac complications post-OLT, such as hypotension, arrhythmia, atrial fibrillation, and myocardial infarction (p=NS). Surgical complications such as bile leak, hepatic artery thrombosis, and graft failure/retransplant were also similar between the groups (p=NS). Median follow-up was 27.2 months, with 1-year patient survival rates of 93% and 91%. There was no difference in allograft and patient survival rates between groups at 1 year and 3 years (log-rank, p=NS).

Conclusions: The presence of coronary artery disease is associated with male gender, increased age, and the presence of diabetes. Carefully selected patients with coronary artery disease may have low complication rates and adequate survival after liver transplant.

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