The Impact of Coronary Artery Disease and Statins on Survival after Liver Transplantation

Abstract

Background:

Cardiovascular disease (CVD) is a major contributor to long-term mortality after liver transplantation (LT) necessitating aggressive modification of CVD risk. However, it is unclear how coronary artery disease (CAD) and development dyslipidemia following LT impacts clinical outcomes and how management of these factors may impact survival.

Methods:

Patients undergoing LT at Virginia Commonwealth University from January 2007 to January 2017 were included (N=495). CAD in all potential LT recipients (LTR) over the age of 50 years or risk factors was evaluated via coronary angiography. Impact of pre-LT CAD after transplantation was evaluated via survival analysis. Additionally, factors associated with new-onset dyslipidemia, statin use, and mortality were assessed using multiple logistic regression or Cox proportional hazards models.

Results:

The mean age of the cohort was 55.3±9.3 years at the time of LT, and median follow-up period was 4.5 years. CAD was noted in 129(26.1%) patients during the pre-LT evaluation. Presence or severity of CAD prior to LT did not impact post-LT survival. Dyslipidemia was present in 96 patients at LT, and 157 patients developed new onset dyslipidemia after LT. Statins were underutilized as only 45% of patients with known CAD were on therapy. In patients with new-onset dyslipidemia, statin therapy was initiated in 111(71%) with median time to initiation of statin therapy was 2.5 years. Statin use conferred survival benefit [HR: 0.25, 95%CI:0.12, 0.49], and was well-tolerated with only 12% of patients developing an adverse event requiring cessation of therapy.

Conclusion:

Pre-LT CAD did not impact survival after LT suggesting potentially a role of accelerated atherosclerosis that may not be captured on pre-LT testing. While statin therapy confers survival benefit, it is underused in LTR.