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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease
Michael Delicce, Joseph Mauch, Abel Joseph, Ruishen Lyu, Heather Kren, Rose Bartow, Donna Ferchill, Maan Fares, Jamile Wakim-Fleming
Michael Delicce, Abel Joseph, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Joseph Mauch, Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH 44195, United States
Ruishen Lyu, Heather Kren, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
Rose Bartow, Donna Ferchill, Department of Liver Transplantation, Cleveland Clinic, Cleveland, OH 44195, United States
Maan Fares, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Jamile Wakim-Fleming, Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Delicce M, Wakim-Fleming J, Lyu R and Fares M designed the research study; Delicce M, Mauch J, Joseph A, Lyu R, Bartow R, Ferchill D and Kren H performed the research; Lyu R performed statistical analysis; Delicce M, Mauch J and Lyu R analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Cleveland Clinic Institutional Review Board [IRB#21-372].
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: The consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Michael Delicce, MD, Doctor, Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States. deliccm@ccf.org
Received: April 5, 2022
Peer-review started: April 5, 2022
First decision: April 28, 2022
Revised: May 10, 2022
Accepted: June 22, 2022
Article in press: June 22, 2022
Published online: July 27, 2022
ARTICLE HIGHLIGHTS
Research background
Nonalcoholic fatty liver disease (NAFLD) is rising in prevalence and is a leading cause of liver transplant. Patients with NAFLD are at increased risk for cardiac disease, which is a known contributor to post-transplant mortality. We aimed to identify cardiac disease that limits survival while on the transplant waitlist.
Research motivation
To identify cardiac disease that limits survival while on the transplant waitlist. This would lead to further insights into how we may need to improve testing and optimization of cardiac disease for patients being considered to liver transplant.
Research objectives
To identify cardiac disease that limits survival while on the transplant waitlist. We found that non-obstructive coronary artery disease (CAD) is associated with failure to survive to liver transplant in patients with NAFLD. Further study is needed to assess impact on pre-transplant outcomes after improvement in medical management of patients with non-obstructive CAD.
Research methods
We performed a retrospective cohort study of patients with NAFLD listed for liver transplant. We analyzed the presence of various cardiac disease states and their association with failure to survive to transplant.
Research results
Mild or moderate coronary artery disease represented a hazard for death or clinical deterioration prior to liver transplant in patients with NAFLD.
Research conclusions
Mild or moderate coronary artery disease represented a hazard for death or clinical deterioration prior to liver transplant. Improvement in identification and management of non-obstructive coronary artery disease may be needed to improved patient outcomes in the pre-transplant period.
Research perspectives
Further study is needed to assess impact on pre-transplant outcomes after improvement in medical management of patients with NAFLD and non-obstructive coronary artery disease who are listed for liver transplant.
