Transplant Trial Watch

A Meta-Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients.

Xiao, J., et al.

Liver Transplantation 2022; 28(4): 689-699.

This study aimed to investigate the prevalence of coronary artery disease (CAD), as well as risk factors and outcomes of patients with CAD prior to receiving a liver transplant.

A literature search was conducted on Medline and Embase. Study selection was performed by two independent reviewers, and data were extracted independently by six authors. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was used to assess the quality of the included studies.

39 studies were included in the review.

Prevalence of patients without CAD screening before LT, risk factors associated with CAD before LT, LT outcomes in patients diagnosed with CAD, and screening modalities for CAD before LT.


CET Conclusions
The systematic review and meta-analysis aims to evaluate the prevalence of coronary artery disease (CAD) among liver transplant candidates, pre-transplant CAD risk factors and whether there is an association between pre-transplant CAD and posttransplant outcomes. Medline and Embase were searched and two independent reviewers screened the titles and abstracts. Data extraction was conducted by independent reviewers and the methodological quality was also assessed although it was not described whether this was done by independent reviewers. Thirty-nine articles were included. The pooled prevalence of CAD in liver transplant candidates was 15.9% with a higher prevalence in high-income countries compared to middle-income countries. Factors associated with CAD before liver transplantation were older age, male sex, type 2 diabetes mellitus, hypertension, hyperlipidemia, history of smoking, nonalcoholic steatohepatitis, hepatitis B virus and hepatocellular carcinoma. The review also found a significant relationship between pre-transplant CAD and posttransplant overall and cardiac-related mortality. The authors stress that prospective studies are needed to inform CAD screening modalities in liver transplant candidates.

Trial registration

Funding source
Not reported