Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation

Babak Azarbal, Paul Poommipanit, Boris Arbit, Antoine Hage, Jignesh Patel, Michelle Kittleson, Saibal Kar, Fady M. Kaldas, Ronald W. Busuttil

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Percutaneous coronary intervention (PCI) has traditionally not been an option for patients with end-stage liver disease (ESLD) and coronary artery disease (CAD). This retrospective study was designed to demonstrate the feasibility and safety of PCI in liver transplant candidates. Patients with ESLD and hemodynamically significant CAD who were otherwise deemed to be acceptable candidates for liver transplantation underwent PCI. The procedural success rates, mortality and myocardial infarction rates, and bleeding outcomes were examined. Sixteen patients with ESLD underwent PCI: 15 with bare-metal stents (1.3 stents per patient on average) and 1 with balloon angioplasty alone. The median diameter stenosis per lesion was 80%, the median platelet count was 68 Ã - 10 9/L, the median international normalized ratio was 1.3, and the median Model for End-Stage Liver Disease score was 13. PCI was successful in 94% of the patients. One patient had a suboptimal residual stenosis of 50% after stenting. There were no in-hospital or 30-day deaths or myocardial infarctions, and no patients developed hematomas. One patient required a 1-U platelet transfusion, and another required 1 U of packed red blood cells. All patients remained clinically stable 1 month after PCI. Nine of the 16 patients were listed for liver transplantation, and 3 patients underwent liver transplantation. In conclusion, we have demonstrated the safety and feasibility of PCI in a small cohort of patients with ESLD and hemodynamically significant CAD, the majority of whom had significant thrombocytopenia. Larger studies are required to determine whether PCI is an effective treatment strategy for patients with ESLD and hemodynamically significant CAD who otherwise would not be candidates for liver transplantation.

Original languageEnglish (US)
Pages (from-to)809-813
Number of pages5
JournalLiver Transplantation
Volume17
Issue number7
DOIs
StatePublished - Jul 1 2011

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End Stage Liver Disease
Percutaneous Coronary Intervention
Liver Transplantation
Safety
Coronary Artery Disease
Stents
Pathologic Constriction
Myocardial Infarction
Platelet Transfusion
International Normalized Ratio
Balloon Angioplasty
Platelet Count
Thrombocytopenia
Hematoma

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation. / Azarbal, Babak; Poommipanit, Paul; Arbit, Boris; Hage, Antoine; Patel, Jignesh; Kittleson, Michelle; Kar, Saibal; Kaldas, Fady M.; Busuttil, Ronald W.

In: Liver Transplantation, Vol. 17, No. 7, 01.07.2011, p. 809-813.

Research output: Contribution to journalArticle

Azarbal, B, Poommipanit, P, Arbit, B, Hage, A, Patel, J, Kittleson, M, Kar, S, Kaldas, FM & Busuttil, RW 2011, 'Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation', Liver Transplantation, vol. 17, no. 7, pp. 809-813. https://doi.org/10.1002/lt.22301
Azarbal, Babak ; Poommipanit, Paul ; Arbit, Boris ; Hage, Antoine ; Patel, Jignesh ; Kittleson, Michelle ; Kar, Saibal ; Kaldas, Fady M. ; Busuttil, Ronald W. / Feasibility and safety of percutaneous coronary intervention in patients with end-stage liver disease referred for liver transplantation. In: Liver Transplantation. 2011 ; Vol. 17, No. 7. pp. 809-813.
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AB - Percutaneous coronary intervention (PCI) has traditionally not been an option for patients with end-stage liver disease (ESLD) and coronary artery disease (CAD). This retrospective study was designed to demonstrate the feasibility and safety of PCI in liver transplant candidates. Patients with ESLD and hemodynamically significant CAD who were otherwise deemed to be acceptable candidates for liver transplantation underwent PCI. The procedural success rates, mortality and myocardial infarction rates, and bleeding outcomes were examined. Sixteen patients with ESLD underwent PCI: 15 with bare-metal stents (1.3 stents per patient on average) and 1 with balloon angioplasty alone. The median diameter stenosis per lesion was 80%, the median platelet count was 68 Ã - 10 9/L, the median international normalized ratio was 1.3, and the median Model for End-Stage Liver Disease score was 13. PCI was successful in 94% of the patients. One patient had a suboptimal residual stenosis of 50% after stenting. There were no in-hospital or 30-day deaths or myocardial infarctions, and no patients developed hematomas. One patient required a 1-U platelet transfusion, and another required 1 U of packed red blood cells. All patients remained clinically stable 1 month after PCI. Nine of the 16 patients were listed for liver transplantation, and 3 patients underwent liver transplantation. In conclusion, we have demonstrated the safety and feasibility of PCI in a small cohort of patients with ESLD and hemodynamically significant CAD, the majority of whom had significant thrombocytopenia. Larger studies are required to determine whether PCI is an effective treatment strategy for patients with ESLD and hemodynamically significant CAD who otherwise would not be candidates for liver transplantation.

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