National Journal of Emergency Medicine SEMI

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 1 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Management of Acute Myocardial Infarction in a Liver Transplant Recipient: A Rare Case Report

Harsha Makwana, Aditi Chaudhary, Harshit Dhongani, Parth Kapadia, Sumit Bhut, Kushal Modi, Megha Chandak

Keywords : Acute myocardial infarction, Case report, Coronary angioplasty, Liver transplant recipient, Thrombolysis

Citation Information : Makwana H, Chaudhary A, Dhongani H, Kapadia P, Bhut S, Modi K, Chandak M. Management of Acute Myocardial Infarction in a Liver Transplant Recipient: A Rare Case Report. 2023; 1 (3):80-83.

DOI: 10.5005/njem-11015-0022

License: CC BY-NC 4.0

Published Online: 25-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Liver transplantation (LT) improves outcomes and quality of life in patients with end-stage liver disease (ESLD). As a result of improved accessibility and recipient survival, transplant candidates are becoming increasingly older, have more comorbidities, and experience more long-term complications, all of which create new challenges in post-transplantation care. In the post-transplant period, a multitude of factors can influence cardiovascular risk in transplant recipients due to aggravation in recipient populations from new-onset dyslipidaemia, hypertension, glucose intolerance, and nephrotoxicity as side effects of immunosuppressive agents. Traditional cardiovascular risk factors are becoming increasingly prevalent in the ageing population of liver transplant candidates, and coronary artery disease (CAD) is considered to be more common than previously thought. Cardiovascular events are recognised as prominent causes of early and late mortality in liver transplant recipients. The most common cardiovascular diseases in transplant candidates are ischaemic CAD and cardiomyopathy. We describe a complex case of a liver transplant recipient in a 50-year-old male patient with no known history of CAD who developed progressive acute myocardial infarction within 6 months of liver transplant and was ultimately thrombolysed to optimise myocardial perfusion. Management of myocardial ischaemia is complicated by a high risk of bleeding in the setting of coagulopathy. Once thrombolysis and haemodynamic stability were achieved, the patient was immediately shifted for coronary angiography, and staged coronary angioplasty was performed for triple vessel coronary disease in the patient at the cardiac institute.

  1. Duffy JP, Kao K, Ko CY, et al. Long-term patient outcome and quality of life after liver transplantation: Analysis of 20-year survivors. Ann Surg 2010;252(4):652–661. DOI: 10.1097/SLA.0b013e3181f5f23a.
  2. Garg A, Armstrong WF. Echocardiography in liver transplant candidates. JACC Cardiovasc Imaging 2013;6(1):105–119. DOI: 10.1016/j.jcmg.2012.11.002.
  3. Keeffe BG, Valantine H, Keeffe EB. Detection and treatment of coronary artery disease in liver transplant candidates. Liver Transplant 2001;7(9):755–761. DOI: 10.1053/jlts.2001.26063.
  4. Heisel O, Heisel R, Balshaw R, et al. New onset diabetes mellitus in patients receiving calcineurin inhibitors: A systematic review and meta-analysis. Am J Transplant 2004;4(4):583–595. DOI: 10.1046/j.1600-6143.2003.00372.x.
  5. Hakeam HA, Al-Jedai AH, Raza SM, et al. Sirolimus induced dyslipidemia in tacrolimus based vs. tacrolimus free immunosuppressive regimens in renal transplant recipients. Ann Transplant 2008;13:46–53. PMID: 18566560.
  6. Trotter JF, Wachs ME, Trouillot TE, et al. Dyslipidemia during sirolimus therapy in liver transplant recipients occurs with concomitant cyclosporine but not tacrolimus. Liver Transplant 2001;7(5):401–408. DOI: 10.1053/jlts.2001.23916.
  7. Glover TE, Watson CJE, Gibbs P, et al. Conversion from calcineurin to mammalian target of rapamycin inhibitors in liver transplantation: A meta-analysis of randomized controlled trials. Transplantation 2016;100(3):621–629. DOI: 10.1097/TP.0000000000001006.
  8. VanWagner LB, Lapin B, Levitsky J, et al. High early cardiovascular mortality after liver transplantation. Liver Transplant 2014;20(11): 1306–1316. DOI: 10.1002/lt.23950.
  9. Koshy AN, Gow PJ, Han HC, et al. Cardiovascular mortality following liver transplantation: Predictors and temporal trends over 30 years. Eur Hear J – Qual Care Clin Outcomes 2020;6(4):243–253. DOI: 10.1093/ehjqcco/qcaa009.
  10. Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012;57(3):675–688. DOI: 10.1016/j.jhep.2012.04.015.
  11. Watt KDS, Pedersen RA, Kremers WK, et al. Evolution of causes and risk factors for mortality postliver transplant: Results of the NIDDK long term follow-up study. Am J Transplant 2010;10(6):1420–1427. DOI: 10.1111/j.1600-6143.2010.03126.x.
  12. Tintinalli JE, Ma OJ, Yealy DM, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th ed. (2019), Section 26, Chapter 297, pp. 1984.
  13. Ang SS, Rao SH, Rizkalla NA, et al. Intraoperative type I acute myocardial infarction during liver transplant requiring intra-aortic balloon pump: A case report. Exp Clin Transplant 2022;20(8):782–785. DOI: 10.6002/ect.2020.0205.
  14. Tandon M, Karna ST, Pandey CK, et al. Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series. World J Hepatol 2017;9(33):1253–1260. DOI: 10.4254/wjh.v9.i33.1253.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.