Liver transplant recipients at increased risk of coronary atherosclerosis

The prevalence and severity of coronary atherosclerosis are significantly higher among recipients of liver transplant than the general population, a study has shown.

A total of 205 liver transplant recipients were matched with 1,025 population controls (median age 56 years, 40 percent women) in this cross-sectional study. All participants completed questionnaires and underwent physical examination and coronary computed tomography angiography.

The investigators categorized coronary atherosclerosis as any, obstructive (≥50 percent stenosis), and extensive (>5 coronary segments) coronary atherosclerosis. They adjusted logistic regressions for age, sex, hypertension, diabetes, dyslipidaemia, smoking, and obesity.

The Systematic Coronary Risk Evaluation 2 score did not differ significantly between recipients and controls (p=0.20). However, liver transplant recipients had greater prevalence of any coronary atherosclerosis (63 percent vs 46 percent; p<0.0001), obstructive coronary atherosclerosis (18 percent vs 10 percent; p<0.0001), and obstructive-extensive coronary atherosclerosis (13 percent vs 6 percent; p<0.0001) than control participants.

After adjusting for confounders, those with a transplanted liver were still more likely to develop any coronary atherosclerosis (odds ratio [OR], 2.19, 95 percent confidence interval [CI], 1.48‒3.27), obstructive coronary atherosclerosis (OR, 2.73, 95 percent CI, 1.43‒5.16), and obstructive-extensive coronary atherosclerosis (OR, 3.90, 95 percent CI, 1.76‒8.55).

Furthermore, liver transplant recipients with any coronary atherosclerosis were more likely to develop high-risk plaque than population controls (OR, 2.10, 95 percent CI, 1.29‒3.45).

“Conscious cardiovascular risk assessment and preventive strategies should be considered in this patient group,” the investigators said.