Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
Liver Transpl. 2010 Nov;16(11):1242-8. doi: 10.1002/lt.22152.
The optimal preoperative cardiac evaluation strategy for patients with end-stage liver disease (ESLD) undergoing liver transplantation remains unknown. Patients are frequently referred for cardiac catheterization, but the effects of coronary artery disease (CAD) on posttransplant mortality are also unknown. We sought to determine the contribution of CAD and multivessel CAD in particular to posttransplant mortality. We performed a retrospective study of ESLD patients undergoing cardiac catheterization before liver transplant surgery between August 1, 2004 and August 1, 2007 to determine the effects of CAD on outcomes after transplantation. Among 83 patients who underwent left heart catheterization, 47 underwent liver transplantation during the follow-up period. Twenty-one of all ESLD patients who underwent liver transplantation (45%) had CAD. Fifteen of the transplant patients with CAD (71%) had multivessel disease. Among transplant patients, the presence of multivessel CAD (versus no CAD) was predictive of mortality (27% versus 4%, P = 0.046), increased length of stay (22 versus 15 days, P = 0.050), and postoperative pressor requirements (27% versus 4%, P = 0.029). Interestingly, neither the presence of any CAD nor the severity of stenosis in any single coronary artery predicted mortality. Furthermore, none of the traditional clinical predictors (age, gender, diabetes, creatinine, ejection fraction, and Model for End-Stage Liver Disease score) were predictive of mortality among transplant recipients. In conclusion, multivessel CAD is associated with higher mortality after liver transplantation when it is documented angiographically before transplantation, even in the absence of severe coronary artery stenosis. This study provides preliminary evidence showing that there may be significant prognostic value in coronary angiography as a part of the pretransplant workup.
对于接受肝移植的终末期肝病 (ESLD) 患者，最佳的术前心脏评估策略仍不清楚。患者经常被转诊进行心导管检查，但冠状动脉疾病 (CAD) 对移植后死亡率的影响也不清楚。我们试图确定 CAD 尤其是多血管 CAD 对移植后死亡率的贡献。我们对 2004 年 8 月 1 日至 2007 年 8 月 1 日期间接受心脏导管检查的 ESLD 患者进行了回顾性研究，以确定 CAD 对移植后结果的影响。在接受左心导管检查的 83 例患者中，有 47 例在随访期间接受了肝移植。所有接受肝移植的 ESLD 患者中有 21 例（45%）患有 CAD。在有 CAD 的移植患者中，有 15 例（71%）患有多血管疾病。在移植患者中，多血管 CAD（与无 CAD 相比）与死亡率（27%比 4%，P=0.046）、住院时间延长（22 天比 15 天，P=0.050）和术后升压要求（27%比 4%，P=0.029）相关。有趣的是，任何 CAD 的存在或任何单个冠状动脉的狭窄程度都不能预测死亡率。此外，在移植受者中，没有任何传统临床预测因素（年龄、性别、糖尿病、肌酐、射血分数和终末期肝病模型评分）可预测死亡率。总之，在移植前通过血管造影术证实存在多血管 CAD 时，即使没有严重的冠状动脉狭窄，也与肝移植后死亡率升高相关。这项研究提供了初步证据，表明在移植前评估中进行冠状动脉造影可能具有重要的预后价值。
