Twofold increased risk of coronary artery disease after liver transplantation: A nationwide Swedish cohort of 2925 patients

INTRODUCTION AND OBJECTIVES: Coronary artery disease (CAD) is common in liver transplant (LT) recipients, but post-LT rates compared to the general population are unknown in Sweden. MATERIALS AND METHODS: We identified all LT recipients in the Swedish National Patient Registry (1987-2020). Each patient was matched with up to 10 population controls for age, sex, municipality, and transplantation year. International Classification of Diseases (ICD) codes defined liver disease aetiology and cardiovascular risk factors. New CAD events were a composite of myocardial infarction, coronary revascularisation, angina, or CAD-related death. Cox regression compared CAD risk in LT recipients and controls across subgroups. RESULTS: We identified 2925 LT recipients and 27,589 controls. Mean age was 54 years; 63% were men. Cardiovascular risk factors were more common in LT recipients. During a median follow-up of 8.0 years, LT recipients had over twice the CAD risk compared with controls (adjusted hazard ratio [aHR]=2.02; 95% confidence interval [CI]=1.80-2.30). Among LT recipients, chronic kidney disease (CKD) (aHR=2.64; 95%CI=1.94-3.60) and previous CAD (aHR=7.85; 95%CI=6.10-10.11) predicted incident CAD. In controls, several factors-including previous CAD, hypertension, diabetes, hypercholesterolemia, CKD, and lung disease-were predictive. CONCLUSIONS: The CAD rate was twofold higher in LT recipients than controls. In recipients, only CKD and prior CAD predicted post-transplant CAD, whereas traditional risk factors predicted CAD in controls.