Guideline Adherence for Secondary Prevention of Stroke and Atherosclerotic Cardiovascular Disease among Liver Transplant Recipients
1Division of GI and Hepatology, Department of Medicine, Northwestern University, Chicago, IL, 2Department of Preventive Medicine, Northwestern University, Chicago, IL, 3Center for Healthcare Studies, Northwestern University, Chicago, IL, 4Department of Pediatrics and Center for Healthcare Studies, Northwestern University, Chicago, IL, 5Departments of Preventive Medicine and Medicine-Cardiology, Northwestern University, Chicago, IL, 6Division of GI and Hepatology, Department of Medicine and Department of Preventive Medicine, Northwestern University, Chicago, IL
Meeting: 2019 American Transplant Congress
Abstract number: B302
Keywords: Heart, Liver transplantation, Post-operative complications, Post-transplant hypertension
Session Information
Session Name: Poster Session B: Liver Retransplantation and Other Complications
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Data about provider adherence to clinical practice guidelines for secondary prevention of stroke and atherosclerotic cardiovascular disease (ASCVD) among liver transplant recipients (LTRs), which are leading causes of long-term mortality after LT, are limited. This study sought to assess adherence to these guidelines and determine if adherence is associated with improved mortality.
*Methods: Prior stroke or ASCVD were identified in an inception cohort, at a large, urban, tertiary care hospital, between 2010-2016, of 602 LTRs, ages 18-79 years, who survived to hospital discharge, using electronic health record data. Cox proportional hazard models assessed the association between guideline adherence and mortality adjusted for key covariates.
*Results: Among 602 LTRs (mean age 56.7 years, 63.8% male, 60.8% non-Hispanic White), stroke and ASCVD prevalence increased yearly post-LT (19% in year 1 to 27% in year 6 for stroke; 60% in year 1 to 68% in year 6 for ASCVD). Rates of statin prescription (any intensity) were low among LTRs with prior stroke (range 7-16%) or ASCVD (range 8-16%). Statin use was not statistically associated with improved mortality in LTRs with stroke (Hazard Ratio (HR) 0.40, 95% confidence interval (CI) 0.12-1.32) or ASCVD (HR 0.66, 95% CI 0.38-1.15). Most LTRs with prior stroke maintained a guideline-recommended average blood pressure (BP) <130/80 mmHg yearly post-LT (53-82%), but meeting this target was not associated with improved mortality (HR 1.20, 95% CI 0.68-2.12). BP control in LTRs with ASCVD was low with only 23-44% maintaining a yearly average BP <130/80 mmHg; achieving this target was not associated with improved mortality (HR 1.18, 95% CI 0.86-1.63).
*Conclusions: Among LTRs, provider adherence to statin guidelines for secondary prevention of stroke and ASCVD is low. Adherence to BP targets is highest among LTRs with prior stroke compared to those with ASCVD. However, adherence to the guidelines was not statistically associated with improved mortality. Prospective study is needed to identify factors for non-adherence and to determine if increased guideline adherence improves outcomes in high-risk LTRs.
To cite this abstract in AMA style:
Campbell PT, Kosirog M, Montag S, Connolly S, Daud A, Das A, Pine S, Finn D, Levitsky J, Holl JL, Lloyd-Jones DM, VanWagner LB. Guideline Adherence for Secondary Prevention of Stroke and Atherosclerotic Cardiovascular Disease among Liver Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/guideline-adherence-for-secondary-prevention-of-stroke-and-atherosclerotic-cardiovascular-disease-among-liver-transplant-recipients/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress