A Meta-Analysis and Systematic Review on the Global Prevalence, Risk factors and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients.

Abstract

BACKGROUND AND AIMS\nThe shift in the changing aetiology of cirrhosis requiring liver transplantation (LT) has resulted in an increasing prevalence of coronary artery disease (CAD) that can potentially impact post-liver transplant outcomes. This systematic review and meta-analysis aim to evaluate the prevalence of CAD, risk factors, and outcomes of patients diagnosed with CAD pre-liver transplant.\n\n\nMETHODS\nMedline and Embase were searched for articles describing CAD in pre-LT patients. Meta-analysis of proportions using the generalized linear mix model was conducted to analyse the pooled prevalence of CAD in pre-LT patients. Associated risk factors for CAD in pre-LT patients and outcomes were evaluated in conventional pairwise meta-analysis.\n\n\nRESULTS\nA total of 39 studies were included. The pooled prevalence of patients diagnosed with CAD before LT was 15.9% (CI: 9.8%-24.7%). Age, male gender, diabetes, hypertension, hyperlipidemia, smoking, non-alcoholic steatohepatitis, hepatitis B and hepatocellular carcinoma were significantly associated with CAD. Patients from high-income countries especially North America, Europe, and South America, with the associated risk factors were at increased risk for CAD pre-LT. CAD pre-LT was associated with an increased odds of overall mortality (OR: 1.4; CI: 1.4 - 1.4; p = 0.01) and cardiac-related mortality (OR: 1.2; CI: 1.1 - 1.3; p = 0.03). A total of 48.7% of included articles considered presence of cardiovascular risk factors for screening of CAD. However, 10.3% of studies screened for CAD in pre-LT patients via invasive coronary angiography only, without stress testing or risk stratification.\n\n\nCONCLUSION\nThis study demonstrates the high prevalence of CAD in pre-LT patients, associated risk factors and outcomes. There is heterogeneity among guidelines and practice in screening for pre-LT CAD, and more studies are needed to establish consensus.