Role of cardiac catheterization and percutaneous coronary intervention in the preoperative assessment and management of patients before orthotopic liver transplantation

Haripriya Maddur, Patrick D. Bourdillon, Suthat Liangpunsakul, A. Joseph Tector, Jonathan A. Fridell, Marwan Ghabril, Marco A. Lacerda, Charlotte Bourdillon, Changyu Shen, Paul Y. Kwo

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Limited data regarding the optimal risk assessment strategy for evaluating candidates for orthotopic liver transplantation (OLT) exist. Our center has adopted a policy of performing cardiac catheterization (CATH) in patients with predefined risk factors, and this is followed by percutaneous coronary intervention (PCI) when it is indicated, even in the presence of negative stress test findings. The aim of this single-center, retrospective study of all patients who underwent OLT between 2000 and 2010 was to assess the effect of our policy on cardiovascular (CV) complications and survival rates after OLT. Data, including 1-year all-cause and CV mortality, postoperative myocardial infarctions (MIs), and frequencies of CATH and PCI, were abstracted. The study was divided into 3 subperiods to reflect the changes in policy over this period: (A) 2000-2004, (B) 2005-2008, and (C) 2009-2010. One thousand two hundred twenty-one patients underwent OLT between 2000 and 2010. The rate of catheterization increased during the 3 time periods (P<0.001), as did the rate of PCI (P<0.05). All-cause mortality decreased over the periods (P<0.001), as did the MI rate (P<0.001). Thirty-five of the 57 patients requiring PCI had normal stress tests. The mortality rate associated with postoperative MIs was significantly higher than the overall all-cause mortality rate. In conclusion, a significant improvement in the overall survival rate over the 3 analyzed time periods was noted. Increases in the frequencies of CATH and PCI corresponded to significant reductions in postoperative MIs and 1-year all-cause mortality rates. The increased use of CATH and PCI was associated with reduced overall all-cause mortality through reductions in the incidence of both fatal and nonfatal MIs. Further analyses of the role of stress testing and CATH in evaluating and treating patients before OLT are required to optimize this process.

Original languageEnglish
Pages (from-to)664-672
Number of pages9
JournalLiver Transplantation
Volume20
Issue number6
DOIs
StatePublished - 2014

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Percutaneous Coronary Intervention
Cardiac Catheterization
Liver Transplantation
Catheterization
Myocardial Infarction
Mortality
Exercise Test
Survival Rate
Retrospective Studies
Incidence

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology
  • Medicine(all)

Cite this

Role of cardiac catheterization and percutaneous coronary intervention in the preoperative assessment and management of patients before orthotopic liver transplantation. / Maddur, Haripriya; Bourdillon, Patrick D.; Liangpunsakul, Suthat; Joseph Tector, A.; Fridell, Jonathan A.; Ghabril, Marwan; Lacerda, Marco A.; Bourdillon, Charlotte; Shen, Changyu; Kwo, Paul Y.

In: Liver Transplantation, Vol. 20, No. 6, 2014, p. 664-672.

Research output: Contribution to journalArticle

Maddur, Haripriya ; Bourdillon, Patrick D. ; Liangpunsakul, Suthat ; Joseph Tector, A. ; Fridell, Jonathan A. ; Ghabril, Marwan ; Lacerda, Marco A. ; Bourdillon, Charlotte ; Shen, Changyu ; Kwo, Paul Y. / Role of cardiac catheterization and percutaneous coronary intervention in the preoperative assessment and management of patients before orthotopic liver transplantation. In: Liver Transplantation. 2014 ; Vol. 20, No. 6. pp. 664-672.
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AU - Fridell, Jonathan A.

AU - Ghabril, Marwan

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AU - Kwo, Paul Y.

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AB - Limited data regarding the optimal risk assessment strategy for evaluating candidates for orthotopic liver transplantation (OLT) exist. Our center has adopted a policy of performing cardiac catheterization (CATH) in patients with predefined risk factors, and this is followed by percutaneous coronary intervention (PCI) when it is indicated, even in the presence of negative stress test findings. The aim of this single-center, retrospective study of all patients who underwent OLT between 2000 and 2010 was to assess the effect of our policy on cardiovascular (CV) complications and survival rates after OLT. Data, including 1-year all-cause and CV mortality, postoperative myocardial infarctions (MIs), and frequencies of CATH and PCI, were abstracted. The study was divided into 3 subperiods to reflect the changes in policy over this period: (A) 2000-2004, (B) 2005-2008, and (C) 2009-2010. One thousand two hundred twenty-one patients underwent OLT between 2000 and 2010. The rate of catheterization increased during the 3 time periods (P<0.001), as did the rate of PCI (P<0.05). All-cause mortality decreased over the periods (P<0.001), as did the MI rate (P<0.001). Thirty-five of the 57 patients requiring PCI had normal stress tests. The mortality rate associated with postoperative MIs was significantly higher than the overall all-cause mortality rate. In conclusion, a significant improvement in the overall survival rate over the 3 analyzed time periods was noted. Increases in the frequencies of CATH and PCI corresponded to significant reductions in postoperative MIs and 1-year all-cause mortality rates. The increased use of CATH and PCI was associated with reduced overall all-cause mortality through reductions in the incidence of both fatal and nonfatal MIs. Further analyses of the role of stress testing and CATH in evaluating and treating patients before OLT are required to optimize this process.

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