Please use this identifier to cite or link to this item:
Title: A prospective natural history study of coronary atherosclerosis following liver transplantation.
Austin Authors: Koshy, Anoop N ;Nerlekar, Nitesh;Gow, Paul John;Lim, Ruth P ;Smith, Gerard;Galea, Michael ;Rodriques, Thalys Sampaio;Lim, Han Sung;Teh, Andrew W ;Farouque, Omar 
Affiliation: Radiology
Victorian Liver Transplant Unit
The University of Melbourne, Parkville, Victoria, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Issue Date: Mar-2022
Date: 2022-01-30
Publication information: Atherosclerosis 2022; 344: 40-48
Abstract: Cardiovascular disease remains a leading cause of mortality following liver transplantation (LT). Whether it may be partially attributable to accelerated development of subclinical coronary artery disease is unclear. We sought to assess the longitudinal effect of LT on coronary plaque burden. A prospective observational study was conducted in 30 asymptomatic patients who underwent computed tomographic coronary angiography (CTCA) pre- and a median 4-years following LT. Serial changes were quantified using coronary artery calcium score (CACS) and semi-quantitative CTCA scores, in a blinded fashion. High-risk plaque (HRP) characteristics were also assessed. Plaque progression was defined using prognostically significant cut-offs. In the study population (age 59.8 ± 8 years, 80% male), 93 of 459 coronary segments had plaque at baseline. On follow-up CTCA, 68 (+73.1%) new lesions appeared in segments without plaque initially. Nineteen (63.3%) patients demonstrated a clinically significant rise in plaque burden on CACS and semi-quantitative indices on CTCA (all p<0.001). CAD-RADS score rose to ≥4 (≥70% stenosis) in 9 (30%) patients, necessitating ischemia-guided revascularization in 3 (10%) patients. While the absence of coronary calcification or plaque pre-LT was protective, presence of HRP and development of post-transplant metabolic syndrome were both strong independent predictors of atherosclerosis progression. Our findings suggest that LT is associated with early progression of coronary atherosclerosis. Accelerated progression was noted particularly in those with HRP and post-transplant metabolic syndrome. Understanding the mechanisms of this novel observation and the potential role of preventive cardiovascular therapies in this population merit further study.
DOI: 10.1016/j.atherosclerosis.2022.01.020
ORCID: 0000-0002-8741-8631
Journal: Atherosclerosis
PubMed URL: 35134655
PubMed URL:
Type: Journal Article
Subjects: Atherosclerosis
Computed tomography
Coronary angiography
Coronary artery disease
Liver transplantation
Natural history
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 3, 2023

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.