Anesth Pain Med.  2022 Oct;17(4):412-419. 10.17085/apm.22168.

Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
Patients with acute-on-chronic liver failure (ACLF) are critically ill and have high waiting-list mortality. Although studies demonstrated that appropriately treated coronary artery disease (CAD) should not be regarded as a contraindication to liver transplant (LT), data regarding long-term outcomes in critically ill liver LT recipients are lacking. The aim of this study was to compare the rates of all-cause death at 5 years following LT in patients with ACLF with or without CAD.
Methods
Between 2010 and 2020, we evaluated 921 consecutive LT patients (MELD score, 32 ± 9) and ACLF classified by CLIF-C ACLF score. Up to 5-year all-cause death according to the CAD status was examined. CAD was defined as a preoperative history of coronary artery bypass graft or a percutaneous intervention and old myocardial infarction. Kaplan-Meier survival analysis was used.
Results
Up to 5 years, 212 (23.0%) of all ACLF patients (n = 921) in whom 17 (29.3%) of 58 CAD patients died. In patients with CAD (6.3%, 58/921), the Kaplan-Meier cumulative mortality rate at 5 years was numerically higher but was not statistically significant when compared with those without CAD (32.9% vs. 23.5%, log-rank, P = 0.25). In subgr oup analysis, there were comparable risks of cumulative mortalities at 5 years across the stratification of ACLF grade 1, 2, and 3 (log-rank P = 0.062, P = 0.72, and P = 0.999, respectively).
Conclusions
All-cause mortality is high in patients with ACLF after LT but is not related to the presence of revascularized or treated CAD, across the stratification of ACLF grades.

Keyword

Acute-on-chronic liver failure; Coronary artery disease; Liver transplantation; Mortality

Figure

  • Fig. 1. Flow diagram.

  • Fig. 2. Kaplan–Meier plot by coronary artery disease (CAD).

  • Fig. 3. Univariable and multivariable cox-proportional hazard regression analysis for the 5-year all-cause mortality. MELD: model for end-disease liver disease, pRBC: packed red blood cell, PRS: post-reperfusion syndrome, CAD: coronary artery disease, CI: confidence interval.

  • Fig. 4. Kaplan–Meier plots by coronary artery disease (CAD) across the stratification of acute-on-chronic liver failure (ACLF) grade 1, 2, and 3. P value < 0.05 is considered significant in the figure.


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