Safety, efficacy, and outcomes of invasive coronary angiography in liver transplant candidates.

BACKGROUND & AIMS: Invasive coronary angiography (ICA) with/without percutaneous coronary intervention (PCI) is recommended in liver transplant (LT) candidates at risk of silent coronary artery disease (CAD). The outcomes and safety of this approach have been scarcely analyzed in Europe.

METHODS

This retrospective, single-center study included all patients assessed as LT candidates between July 2015 and December 2022. Outcomes before and after LT were compared between patients with and without ICA as part of pre-LT assessment. Findings and outcomes of ICA were recorded.

RESULTS

A total of 912 patients were considered for LT, of whom 202 had an ICA. Patients with ICA more frequently presented contraindications for LT ( = 0.026). Severe (>70%) CAD was found in 29/202 cases (14%), and PCI was performed in 18 (9%). All patients received drug-eluting stents, and the duration of dual antiplatelet therapy (DAPT) was 1 month in 80%. Eight patients (4%) presented complications, which were more frequent in patients who received PCI (22%). One patient died from acute-on-chronic liver failure after post-DAPT bleeding. In the 516 patients who underwent transplantation, the incidence of cardiovascular events (CVEs) increased with the burden of CAD, from 11% in patients without ICA indication to 43% in patients with PCI ( <0.001), without differences in mortality ( = 0.529).

CONCLUSIONS

In a contemporary cohort of LT candidates, ICA was associated with a low incidence of complications, although some of these, related to DAPT, can be life-threatening. The burden of disease in ICA correlates with the incidence of post-LT CVEs, although this did not result in a higher mortality.

IMPACT AND IMPLICATIONS

Invasive coronary angiography (ICA) is performed in potential liver transplant (LT) candidates to identify severe coronary artery disease that may either be treated to permit LT or contraindicate LT if untreatable, but its safety and outcomes are not well defined. We show that ICA is associated with a low incidence of complications in LT candidates, although severe coronary artery disease requiring percutaneous treatment followed by dual antiplatelet therapy increased the risk of severe complications. In addition, ICA identifies patients with untreatable disease that can contraindicate LT. Finally, the higher the burden of disease on ICA, the higher the incidence of post-LT cardiovascular events, although this was not associated with increased post-LT mortality. These results support the use of ICA in LT candidates, although being aware of the potential risks is crucial for physicians and patients.