SEATTLE — Underlying coronary artery disease should not be an automatic contraindication to orthotopic liver transplantation, Kabir Julka, M.D., said at the American Transplant Congress.
Coronary artery disease (CAD) is a relative contraindication to liver and other organ transplants, but a retrospective review showed no differences in either peri- or postoperative surgical outcomes in orthotopic liver transplantation patients with stable disease who were well managed, compared with patients without CAD, explained Dr. Julka of Northwestern University, Chicago.
Patients with CAD are generally not considered good candidates for transplantation because of the belief that they are at higher risk for complications.
However, the literature regarding surgical outcomes in patients undergoing orthotopic liver transplantation with underlying CAD is sparse.
“Liver transplantation is a high-risk procedure, and we did try to select the most optimized patient population. But in our experience at Northwestern, we noticed that some of our patients with treatable heart disease appeared to do well following a transplant, so we decided to see if there were differences in outcome,” Dr. Julka said in a poster presentation at the congress, which was cosponsored by the American Society of Transplantation and the American Society of Transplant Surgeons.
In a chart review of 298 patients who had undergone orthotopic liver transplantation during August 1993-January 2003, Dr. Julka and colleagues identified 21 patients with CAD.
Of this group, six patients had a pretransplant or simultaneous bypass; eight underwent percutaneous transluminal coronary angioplasty, stent placement, or both; and the remaining patients were managed medically.
The 21 patients with CAD were then matched to controls by age, gender, etiology, and severity of liver disease.
The researchers compared the two groups in terms of peri- and postoperative complications, time to extubation, length of intensive care unit and hospital stays, and 1-year graft and patient survival.
There were more perioperative complications in patients with coronary artery disease, compared with control patients (five vs. one, respectively), but the difference was not statistically significant.
Postoperative complications (five vs. four), median time to extubation (2 days vs. 1 day), median length of ICU stay (3 days vs. 2 days), or median length of hospital stay (8 days vs. 5 days) did not differ significantly between the two groups.
The 1-year graft survival rate for CAD patients was 81%, vs. 77% for controls; patient survival rates also did not differ (81% vs. 90%).
At 1 year after transplantation, there really wasn't any difference between the patients with CAD and those without it, said Dr. Julka, who acknowledged that the patient population was small.
“If we had more patients to power it, maybe we might have seen some differences,” he said.