The incidence of coronary artery disease after liver transplant: a meta-analysis

Abstract Purpose to investigate the incidence of coronary artery disease (CAD) events after liver transplant. Background Liver transplant (LT) can cure end-stage liver failure. CAD is a known complication after LT surgery. The incidence of CAD after LT is not well-established on short- and long-term perspectives. Methods We performed data searches in the PubMed till December 31, 2022. Inclusion criteria were observational trials evaluating new events of CAD in LT patients. Exclusion criteria were lack of follow-up CAD events after LT. Our primary outcome was the composite incidence of new myocardial infarctions (MIs), revascularisation due to CAD, and angina. The incidence of CAD was calculated through a generalised mixed effect meta-analysis. Sensitivity analyses were the incidence of MI, distinction of the short-term(≤12 months) and long-term(>12 months) incidences rates(new cases/months) of CAD, and univariate meta-regressions of study baseline characteristics and the CAD incidence. Results A total of 426 studies were retreated from PubMed (Figure 1). Of these, 23 studies were eligible for the meta-analysis. Age of patients ranged from 50 to 67 years. Female participants differed between 20 to 42%. CAD was prevalent in 1 to 60% before liver transplant. The incidence of CAD was 3% (95% CI, 2 to 5%). The incidence of MI was 1% (95% CI, 1 to 3%). The incidence rate was 4.40 (95% CI, 1.74 to 11.15) for follow-ups ≤ 12 months as compared to 0.22 (95% CI, 0.13 to 0.37) for follow-ups > 12 months (Figure 2). Meta-regressions showed prevalent CAD and number of study particants to be significantly associated with higher versus lower CAD incidence after LT (P = 0.03 & P < 0.001). Conclusion The CAD incidence after LT was 3%. Despite high heterogeneity among studies, existing CAD before LT is a signifant risk factor for new CAD events. Incidence rates showed the CAD to be higher close to LT surgery.Figure 1:Flow chartFigure 2:incidence rates of CAD