IDDF2021-ABS-0095 A meta-analysis and systematic review on the global prevalence, risk factors and outcomes of coronary artery disease in liver transplant recipients

BackgroundThe changing demographics of waitlisted liver transplantation (LT) patients and shift in etiology of liver disease result in increasing prevalence of coronary artery disease (CAD), which can impact post-LT outcomes. This study aims to evaluate the prevalence of CAD among potential LT recipients, describe the risk factors of CAD and investigate the impact of pre-LT CAD on post-LT outcomes.MethodsTwo electronic databases, MEDLINE and EMBASE, were searched for articles describing the CAD in pre-LT patients. Articles that describe the prevalence, risk factors and outcomes of pre-LT patients diagnosed with CAD were included. Generalized linear mixed model (GLMM) and Clopper-Pearson intervals to stabilize the variance were used to tabulate the prevalence of CAD in pre-LT patients and outcomes post-LT. The prevalence of CAD in pre-LT patients was stratified across different regions and countries of varying income levels. Risk factors of CAD and outcomes were analyzed with regression or pairwise analysis.ResultsTotal of 39 articles were included. The pooled prevalence of 15,880 patients from 34 studies diagnosed with CAD before LT was 15.88% (CI: 9.81% - 24.69%, IDDF2021-ABS-0095 Figure 1. Screening Method of CAD before Liver Transplant). LT candidates in high-income countries had markedly higher odds of CAD (OR: 10.5; CI: 8.12 – 13.7; p < 0.0001) compared to patients in middle-income countries. Age, male, presence of diabetes, hypertension, hyperlipidemia, smoking, non-alcoholic steatohepatitis, hepatitis B and hepatocellular carcinoma were significantly associated with CAD. CAD diagnosis prior to LT was a significant risk factor for overall mortality (OR: 1.42; CI: 1.40 – 1.43; p = 0.0140) and cardiac-related mortality (OR: 1.18; CI: 1.10 – 1.27; p = 0.0347) post-LT. North America had the highest pooled prevalence of CAD in pre-LT patients at 23.61% (CI: 14.07% - 36.83%) amongst South America, Europe, Middle east, Asia and Oceania. 69% of the included studies utilized non-invasive stress tests and invasive coronary angiograms in their pre-LT cardiac assessment (IDDF2021-ABS-0095 Figure 2. Global Prevalence of CAD before Liver Transplant).ConclusionsThis meta-analysis and systematic review demonstrate the high prevalence of CAD in pre-LT patients, the associated risk factors and outcomes. More studies are required to determine the optimal screening methodology for CAD in pre-LT patients.