Long-Term Survival in Liver Transplant Patients With Coronary Artery Disease: A Multi-Institutional Study

Background: The age of liver transplant (LT) recipients continues to increase, and as a result, the prevalence of coronary artery disease (CAD) has risen. Long-term post-transplant outcomes in LT patients with CAD are poorly understood. Objectives: We previously demonstrated in a multi-institutional LT cohort that early post-transplant survival was similar between recipients with angiographically-proven, treated CAD and those with no CAD and nonobstructive CAD. We now present a follow-up study in this same cohort. Our objective is to determine long-term post-transplant survival in LT recipients with known pretransplant CAD. All-cause mortality is the primary outcome. Methods: We performed a retrospective analysis for post-transplant survival in 604 adult LT recipients who underwent angiography prior to LT at 7 institutions between 1998 and 2010. Results: Angiographically-proven obstructive CAD (≥50% stenosis) was present in 145 of 604 patients (24%). No CAD or nonobstructive CAD was found in 459 patients (76%). Mortality was higher in patients with CAD (adjusted HR: 1.39; CI: 1.06-1.82; P = 0.0159) than in those without CAD. Patients with CAD were further stratified by CAD severity and by pretransplant coronary revascularization. Mortality was higher in patients with severe CAD as defined by >70% vessel stenosis (adjusted HR: 1.63; CI: 1.19-2.22; P = 0.002) and in patients that underwent revascularization (adjusted HR: 1.62; 95% CI: 1.18-2.23, P = 0.003) than in those without CAD. Mean follow-up time was 87.6 ± 55.6 months (7.3 ± 4.6 years) for all patients. Conclusions: Contrary to our previous report, this investigation suggests that long-term post-transplant survival is adversely affected by underlying obstructive CAD.