MYOCARDIAL-ISCHEMIA AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

A hypercoaguble state exists after orthotopic liver transplantation. T his hematologic abnormality may predispose patients to coronary thromb o sis and unstable angina. The incidence of postoperative myocardial i schemia in such patients is unknown. Suitable electrocardiograms and c linical events of consecutive patients undergoing ortho topic liver tr ansplantation (n = 45) and major Intraabdominal surgery (n = 28) durin g a 3-month period at a major university teaching hospital and transpl ant center were examined retrospectively. Clinical myocardial ischemia or ischemic electrocardiographic changes, or both, occurred in 6 tran splant patients compared with no patient in the nontransplant or compa rison group. In 4 of the 6 patients with dramatic electrocardiographic changes and ischemic events, coronary arteriography failed to demonst rate significant obstructive disease. It is concluded that severe myoc ardial ischemia may occur in patients after orthotopic liver transplan tation in the absence of significant coronary disease. A hypercoagulab le state may predispose to coronary thrombosis in this setting, provid ing insight (and a future model for study) into the development of uns table angina.