Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure
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-te...
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| Language: | English |
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Korean Society of Anesthesiologists
2022-10-01
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| Series: | Anesthesia and Pain Medicine |
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| Online Access: | http://www.anesth-pain-med.org/upload/pdf/apm-22168.pdf |
| _version_ | 1797825402263044096 |
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| author | Hye-Mee Kwon Jae Hwan Kim Ji-Young Kim Gyu-Sam Hwang |
| author_facet | Hye-Mee Kwon Jae Hwan Kim Ji-Young Kim Gyu-Sam Hwang |
| author_sort | Hye-Mee Kwon |
| collection | DOAJ |
| description | 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 subgroup 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. |
| first_indexed | 2024-03-13T10:53:29Z |
| format | Article |
| id | doaj.art-95d87cbf3adb4ae2bbe6fbc8f6d6c4bd |
| institution | Directory Open Access Journal |
| issn | 1975-5171 2383-7977 |
| language | English |
| last_indexed | 2024-03-13T10:53:29Z |
| publishDate | 2022-10-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Anesthesia and Pain Medicine |
| spelling | doaj.art-95d87cbf3adb4ae2bbe6fbc8f6d6c4bd2023-05-17T06:01:35ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772022-10-0117441241910.17085/apm.221681161Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failureHye-Mee Kwon0Jae Hwan Kim1Ji-Young Kim2Gyu-Sam Hwang3 Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaBackground 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 subgroup 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.http://www.anesth-pain-med.org/upload/pdf/apm-22168.pdfacute-on-chronic liver failurecoronary artery diseaseliver transplantationmortality |
| spellingShingle | Hye-Mee Kwon Jae Hwan Kim Ji-Young Kim Gyu-Sam Hwang Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure Anesthesia and Pain Medicine acute-on-chronic liver failure coronary artery disease liver transplantation mortality |
| title | Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure |
| title_full | Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure |
| title_fullStr | Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure |
| title_full_unstemmed | Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure |
| title_short | Five-year all-cause mortality in critically ill liver transplant patients with coronary artery disease: analysis of acute-on chronic liver failure |
| title_sort | five year all cause mortality in critically ill liver transplant patients with coronary artery disease analysis of acute on chronic liver failure |
| topic | acute-on-chronic liver failure coronary artery disease liver transplantation mortality |
| url | http://www.anesth-pain-med.org/upload/pdf/apm-22168.pdf |
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