Satapathy Sanjaya K, Vanatta Jason M, Helmick Ryan A, Flowers Albert, Kedia Satish K, Jiang Yu, Ali Bilal, Eason James, Nair Satheesh P, Ibebuogu Uzoma N
1 Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN. 2 Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN. 3 School of Public Health, University of Memphis, Memphis, TN. 4 Department of Cardiology, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN.
Transplantation. 2017 Apr;101(4):793-803. doi: 10.1097/TP.0000000000001647.
Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). We aim to assess survival in LT recipients based on presence, severity, extent of CAD, and cardiac events within 90 days of LT.
Eighty-seven LT recipients with history of pre-LT angiogram (December 2005 to December 2012) were compared with 2 control groups without prior angiogram, 72 LT recipients matched for cardiovascular risk factors (control group I), and 119 consecutive LT recipients without any CV risk factors (control group II). CAD was assessed by (1) vessel score (≥50% reduction in luminal diameter), and (2) Extent score (Reardon scoring system).
Of the 87 LT recipients (study group), 58 (66.7%) had none or less than 50% stenosis, 29 (33.3%) had obstructive CAD (≥50% stenosis), 7 (8%) with single-vessel disease, and 22 (25.3%) with multivessel disease. In the study group, irrespective of prerevascularization severity of CAD (P = 0.357), number of segments involved (0, 1-2, > 2 segments, P = 0.304) and extent of CAD based on Reardon score (0, 1-9, >10, P = 0.224), comparable posttransplant survival was noted. Overall, patient survival in the revascularized CAD group was comparable to angiogram group without obstructive CAD, and both control group I and control group II (P = 0.184, Log Rank). Postoperative cardiac events within 90 days of LT predicted poor survival in study group as well as control groups.
Severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. Early postoperative cardiac events are associated with inferior survival in LT recipients, irrespective of underlying CAD.
冠状动脉疾病（CAD）是肝移植（LT）评估过程中的一个重要问题。我们旨在根据CAD的存在、严重程度、范围以及LT术后90天内的心脏事件来评估LT受者的生存率。
将87例有LT术前血管造影史（2005年12月至2012年12月）的LT受者与2个无术前血管造影的对照组进行比较，72例匹配心血管危险因素的LT受者（对照组I），以及119例无任何心血管危险因素的连续LT受者（对照组II）。通过（1）血管评分（管腔直径减少≥50%）和（2）范围评分（里尔登评分系统）评估CAD。
在87例LT受者（研究组）中，58例（66.7%）无狭窄或狭窄程度小于50%，29例（33.3%）有阻塞性CAD（狭窄≥50%），7例（8%）为单支血管病变，22例（25.3%）为多支血管病变。在研究组中，无论CAD血管重建术前的严重程度（P = 0.357）、受累节段数（0、1 - 2、>2节段，P = 0.304）以及基于里尔登评分的CAD范围（0、1 - 9、>10，P = 0.224）如何，均观察到相似的移植后生存率。总体而言，血管重建的CAD组患者生存率与无阻塞性CAD的血管造影组以及对照组I和对照组II相当（P = 0.184，对数秩检验）。LT术后90天内的心脏事件预示着研究组以及对照组的生存率较差。
如果进行了适当的血管重建，CAD的严重程度或范围不会影响LT术后生存率。LT术后早期心脏事件与LT受者较差的生存率相关，无论其潜在的CAD情况如何。
