J Am Coll Cardiol. 2026 Mar 4:S0735-1097(26)00207-X. doi: 10.1016/j.jacc.2026.01.041. Online ahead of print.
ABSTRACT
BACKGROUND: Prevalence and severity of coronary atherosclerosis in liver transplant (LTx) recipients remain poorly characterized because prior work has relied on clinically indicated imaging or retrospective studies.
OBJECTIVES: The purpose of this study was to determine the prevalence and severity of coronary atherosclerosis in LTx recipients compared with control subjects using protocolized research-coronary CT angiography in both LTx recipients and control subjects.
METHODS: In this cross-sectional study, LTx recipients aged ≥40 years from the DACOLT (Danish Comorbidity in Liver Transplant Recipients) study were matched 1:5 by age and sex with population controls from the Copenhagen General Population Study. Questionnaires, physical examinations, and coronary computed tomography angiography were performed uniformly in all participants. Coronary atherosclerosis was categorized as any, obstructive (≥50% stenosis), and extensive (>5 coronary segments) coronary atherosclerosis. Logistic regressions were adjusted for age, sex, hypertension, diabetes, dyslipidemia, smoking, and obesity.
RESULTS: We included 205 LTx recipients and 1,025 population control subjects. Median age was 56 years, and 40% were women. SCORE2 (Systematic COronary Risk Evaluation 2) risk did not differ significantly between LTx recipients and control subjects (P = 0.20). LTx recipients had significantly higher prevalence of any coronary atherosclerosis (63% vs 46%; P < 0.0001), obstructive coronary atherosclerosis (18% vs 10%; P < 0.0001), and obstructive-extensive coronary atherosclerosis (13% vs 6%; P < 0.0001), than control subjects. After adjusting for confounders, living with a transplanted liver remained associated with higher odds of any coronary atherosclerosis (OR: 2.19; 95% CI: 1.48-3.27), obstructive coronary atherosclerosis (OR: 2.73; 95% CI: 1.43-5.16), and obstructive-extensive coronary atherosclerosis (OR: 3.90; 95% CI: 1.76-8.55). Among individuals with any coronary atherosclerosis, LTx recipients had higher odds of having high-risk plaque than population control subjects (OR: 2.10; 95% CI: 1.29-3.45).
CONCLUSIONS: LTx recipients had a significantly higher prevalence and severity of coronary atherosclerosis compared with matched general population control subjects, after adjusting for traditional cardiovascular risk factors. Conscious cardiovascular risk assessment and preventive strategies should be considered in this patient group. (The Danish Comorbidity in Liver Transplant Recipients Study [DACOLT]; NCT04777032).
PMID:41778959 | DOI:10.1016/j.jacc.2026.01.041