Coronary CT before Liver Transplantation Guy J Friedrich, MD
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1 Coronary CT before Liver Transplantation Guy J Friedrich, MD Medical University Innsbruck, Austria
2 Coronary CT before Liver Transplantation Guy J Friedrich, MD Medical University Innsbruck, Austria No disclosures
3 Coronary artery disease: a problem in End Stage Liver Disease Patients? -CAD major cause of morbidity and mortality in the post transplant course in liver tx patients? -Growing evidence of CAD presence in ESLD patients
4 Coronary artery disease: a problem in End Stage Liver Disease Patients? Change of mind concerning epidemics of CAD in ESLD patients: Potential protective effects on the cardiovascular system of ESLD (low blood pressure, low cholesterol, increased oestrogen) not as relevant as thought initially s angiographic evidence of CAD in up to 30 % of ESLD patients - Incidence of CAD in ESLD patients at least equal to age-matched general population, even higher? - Premature CAD frequent? - Except recurrent disease and de novo malignancies CAD is representing the most common cause of death in orthotopic liver transplant patients
5 Coronary artery disease: a problem in End Stage Liver Disease Patients? Change of mind concerning epidemics of CAD in ESLD patients: - The referral of older candidates for liver transplantation has increased - The prevalence of CAD risk factors in the ESLD populaton has increased - Identification and treatment of patients with subclinical CAD is mandatory in the pre LTX assessment
6 Coronary artery disease: a problem in End Stage Liver Disease Patients? Orthotopic liver transplantation interventions are stressing the cardiovascular system. Cardiac complications after OLT are frequent. Following literature cardiac causes are the leading cause of death (24%) after OLT.
7 Coronary artery disease: a problem in End Stage Liver Disease Patients? Detection of stenotic CAD
8 MSCT R.Erbel, Herz, 1996
9 Diagnostic pathways in CAD 1) Case history-treadmill-scinti-msct-invasive CA 2) Case history-teamill-msct-scinti-invasive CA 3) Case history-treadmill-msct-invasive CA 4) Case history-scinti-treadmill-invasive CA 5) Case history-msct-invasive CA 6) Case history-scinti-invasive CA 7) Case history invasive CA????
10 Diagnostic pathways in suspected CAD in ESLD 1) Case history-treadmill-scinti-msct-invasive CA 2) Case history-treadmill-msct-scinti-invasive CA 3) Case history-treadmill-msct-invasive CA 4) Case history-scinti-treadmill-invasive CA 5) Case history-msct-invasive CA 6) Case history-scinti-invasive CA 7) Case history invasive CA Patients rarely suitable!!
11 Non invasive stress testing before liver transplant surgery Treadmill testing.poor sensitivity, not suitable candidates Dobutamine Stress Echocardiography poor positive predictive value, highly operator dependent Pharmacologic stress scintigraphy false positive values frequent
12 Contraindications for Liver Transplantation
13 POST Liver Transplantation Complications
14 Pre Liver Transplant risk stratification program in patients with End Stage Liver Disease including Coronary CT imaging Diagnostic pathway development :
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20 Cardiovascular screening of patients before liver transplantation 80 patients Group 1 MSCTA 54/80 pts Group 2 CA (no MSCTA) 10/80 pts Group 3 No MSCTA + No CA 16/80 pts CA 24/54 Liver Transplantation Post-LT Outcome
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22 Coronary CT angiography for preop risk stratification in Liver Transplant recipients CCT is a reliable non invasive tool to determine prevalence of CA in ESLD patients CCT may reduce the number of invasive coronary angiographies in these patients CCT helps to better define preop risk stratification in patients scheduled for liver transplantation Radiation exposure has to be outweighed by potential bleeding complications during invasive diagnostics Further prospective and randomized studies are needed
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