The Impact of Coronary Artery Disease and Statins on Survival After Liver Transplantation
Autor: | Samarth Patel, Viviana Rodríguez, Chandra Bhati, Adam Sima, Anchalia Chandrakumaran, Danielle L. Kirkman, John Laurenzano, Joseph Clinton, Masoud Faridnia, Erika Liptrap, Gurukripa N. Kowlgi, Mohammad S. Siddiqui, Mohammad Bilal Siddiqui, Fei-Pi Lin |
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Rok vydání: | 2019 |
Předmět: |
Male
Graft Rejection medicine.medical_specialty medicine.medical_treatment Kaplan-Meier Estimate Coronary Artery Disease 030230 surgery Liver transplantation Coronary Angiography Severity of Illness Index Article End Stage Liver Disease Coronary artery disease 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Postoperative Period cardiovascular diseases Survival analysis Dyslipidemias Transplantation Hepatology Proportional hazards model business.industry Hazard ratio Middle Aged medicine.disease Kidney Transplantation Liver Transplantation Treatment Outcome Preoperative Period Cohort Female 030211 gastroenterology & hepatology Surgery Hydroxymethylglutaryl-CoA Reductase Inhibitors business Dyslipidemia Follow-Up Studies |
Zdroj: | Liver Transpl |
ISSN: | 1527-6473 1527-6465 |
DOI: | 10.1002/lt.25613 |
Popis: | Cardiovascular disease (CVD) is a major contributor to longterm mortality after liver transplantation (LT) necessitating aggressive modification of CVD risk. However, it is unclear how coronary artery disease (CAD) and the development of dyslipidemia following LT impacts clinical outcomes and how management of these factors may impact survival. Patients undergoing LT at Virginia Commonwealth University from January 2007 to January 2017 were included (n = 495). CAD and risk factors in all potential liver transplantation recipients (LTRs) over the age of 50 years were evaluated via coronary angiography. The impact of pre-LT CAD after transplantation was evaluated via a survival analysis. Additionally, factors associated with new-onset dyslipidemia, statin use, and mortality were assessed using multiple logistic regression or Cox proportional hazards models. The mean age of the cohort was 55.3 ± 9.3 years at the time of LT, and median follow-up was 4.5 years. CAD was noted in 129 (26.1%) patients during the pre-LT evaluation. The presence or severity of pre-LT CAD 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 underused as only 45.7% of patients with known CAD were on therapy. In patients with new-onset dyslipidemia, statin therapy was initiated in 111 (71.1%), and median time to initiation of statin therapy was 2.5 years. Statin use conferred survival benefit (hazard ratio, 0.25; 95% confidence interval, 0.12-0.49) and was well tolerated with only 12% of patients developing an adverse event requiring the cessation of therapy. In conclusion, pre-LT CAD did not impact survival after LT, potentially suggesting a role of accelerated atherosclerosis that may not be captured on pre-LT testing. Although statin therapy confers survival benefit, it is underused in LTRs. |
Databáze: | OpenAIRE |
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