Objective To analyze the effects of clinical pathway management on the prognosis of orthotopic liver transplanta⁃ tion with donation after cardiac death (DCD) in patients with severe coronary atherosclerotic heart disease (coronary artery disease) us⁃ ing clinical data such as major adverse cardiovascular events (MACE) and postoperative mortality Methods A total of 359 adult pa⁃ tients who underwent orthotopic liver transplantation with DCD in Beijing Friendship Hospital from February 1, 2015 to December 31, 2019 were selected and their clinical data were retrospectively analyzed. Sixty patients undergoing computed tomography angiography (CTA) before surgery were enrolled and divided into two groups: a severe coronary heart disease group (n=13) and a non⁃severe coro⁃ nary heart disease group (n=47). Based on different methods of clinical pathway management, both groups were compared for baseline demographic characteristics, traditional cardiovascular risk factors, preoperative cardiac function, renal function, end⁃stage liver dis⁃ ease classification, preoperative biochemical parameters, warm ischemia time, portal vein block time, vena cava block time, intraopera⁃ tive hypotension rate and other perioperative indicators, postoperative heart adverse events, and mortality. Results There was no sig⁃ nificant difference in demographic data between the two groups (P>0.05). Their troponin I (TnI) were in the normal range before opera⁃ tion, but TnI was higher in patients with severe coronary heart disease than those without severe coronary heart disease (P<0.05). Be⁃ fore surgery, the severe coronary heart disease group showed higher levels of lactic acid than the non⁃severe coronary heart disease group (P<0.05). There was no significant difference in other baseline data (P>0.05). There was no significant difference in preoperative blood pressure and heart rate between the two groups (P>0.05), as well as in warm ischemia time, portal vein block time, vena cava block time and hypotension rate between the two groups (P>0.05). After surgery, the severe coronary heart disease group produced sig⁃ nificantly lower levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) than the non⁃severe coronary heart dis⁃ ease group (P<0.05). There was no significant difference in blood pressure, heart rate, ⁃ and lactate levels (P>0.05). There was no signif⁃ icant difference in mortality between the two groups (P>0.05), and the incidence of MACE in the severe coronary heart disease group was significantly higher than that in the non⁃severe coronary heart disease group (P<0.05). Conclusions Severe coronary artery dis⁃ ease is not the contraindication of orthotopic liver transplantation with DCD. But the incidence of MACE significantly increases after op⁃ eration. Optimizing clinical pathway management is essential to improve the clinical outcome of patients with severe coronary artery dis⁃ ease.