The Impact of Coronary Artery Disease and Statins on Survival After Liver Transplantation.
Coronary Angiography
Coronary Artery Disease
/ complications
Dyslipidemias
/ complications
End Stage Liver Disease
/ complications
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ therapeutic use
Kaplan-Meier Estimate
Liver Transplantation
Male
Middle Aged
Postoperative Period
Preoperative Period
Risk Factors
Severity of Illness Index
Treatment Outcome
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
12
05
2019
accepted:
03
07
2019
pubmed:
26
7
2019
medline:
12
9
2020
entrez:
26
7
2019
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 31344758
doi: 10.1002/lt.25613
pmc: PMC6754286
mid: NIHMS1043471
doi:
Substances chimiques
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1514-1523Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002649
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Association for the Study of Liver Diseases.
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