Preoperative Risk Factor-based Cardiac Catheterization Is Associated With Low Cardiac Morbidity And Mortality In Liver Transplant Patients

R. Rachwan¹, I. Kutkut¹, P. D. Bourdillon², L. R. Timsina³, M. Ghabril⁴, C. A. Kubal⁵, M. A. Lacerda⁶, R. S. Mangus⁵

¹Internal Medicine, Indiana University, Indianapolis, IN, ²Internal Medicine, Indiana University, Division of Cardiology, Indianapolis, IN, ³Department of Biostatistics, Indiana University, Indianapolis, IN, ⁴Internal Medicine, Indiana University, Division of Hepatology, Indianapolis, IN, ⁵Surgery, Transplant Division, Indiana University, Indianapolis, IN, ⁶Internal Medicine, Division of Hepatology, Indiana University, Indianapolis, IN

Meeting: 2019 American Transplant Congress

Abstract number: A309

Keywords: Liver transplantation, Outcome, Screening

Session Information

Session Name: Poster Session A: Liver: Recipient Selection

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Mortality post-liver transplant historically was largely attributed to coronary artery disease (CAD). Current guidelines recommend screening with non-invasive modalities in patients with risk factors. An analysis of 1221 liver transplant patients at Indiana University (IU) found a reduction in the incidence of myocardial infarction with increased frequency of cardiac catheterization (CATH) and percutaneous coronary intervention (PCI) over the years 2000-2010. This study is a follow-up to determine the effectiveness of our previously published screening criteria.

*Methods: 811 patients underwent liver transplantation at IU from 2010 to 2016 and received pre-transplant cardiac evaluation by a single cardiologist. CATH was performed in patients with predefined risk factors (age >65, diabetes, hypertension, obesity, smoking, family and personal history of CAD) followed by PCI in cases of significant CAD (>50% stenosis), despite negative stress test findings. Retrospective data were extracted including demographics, cardiovascular risk factors, CATH, stress testing, and death.

*Results: There were 766 patients (94%) that had stress testing, of which 535 (70%) were followed by CATH. The sensitivity of stress echocardiography in detecting significant CAD requiring PCI was 37%. There were significant differences (P<0.05) in age, gender, hypertension, and personal history of CAD between patients requiring PCI versus no PCI. Diabetes reached near significance (P=0.05). Total number of deaths was 131, of which 3 were related to Acute Coronary Syndrome (ACS) during the studied period. ACS deaths at 1 year were 0/17 (no CATH), 1/24 (normal coronaries), 1/14 (non-obstructive CAD), and 0/9 (significant CAD). Revascularization lead to comparable results for ACS mortality at 1 year between the groups, which was also comparable to the 2009-2010 cohort managed using the same protocol in our previous study (1/11). Total 1-year mortality was comparable at 8% (64/811) vs. 6% (11/174) from the prior study.

*Conclusions: Sixty-three percent of liver transplant patients who received PCI had negative stress echocardiography, indicating stress testing may not be reliable for liver transplant patients. Our protocol of aggressive CAD screening, with CATH based on specific risk factors, and a lower threshold for PCI was associated with low ACS mortality across all groups.

To cite this abstract in AMA style:

Rachwan R, Kutkut I, Bourdillon PD, Timsina LR, Ghabril M, Kubal CA, Lacerda MA, Mangus RS. Preoperative Risk Factor-based Cardiac Catheterization Is Associated With Low Cardiac Morbidity And Mortality In Liver Transplant Patients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/preoperative-risk-factor-based-cardiac-catheterization-is-associated-with-low-cardiac-morbidity-and-mortality-in-liver-transplant-patients/. Accessed May 12, 2025.

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