Coronary CT scan for the screening of asymptomatic coronary disease in liver transplant candidates

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-01 DOI:10.1016/j.dld.2025.08.029

L. Iogna Prat , E. Fumolo , D. Bitetto , E. Fornasiere , M. Puppato , A. Vit , M. Sponza , P. Toniutto

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引用次数: 0

Abstract

Background

Coronary artery disease (CAD) is the most frequent cause of non-graft related death among liver transplant (OLT) recipients. There is a lack of evidence supporting the systematic use of coronary CT scan (CCT) to evaluate the presence of CAD in OLT candidates with cardiovascular risk factors.

Aims

To assess: 1) the prevalence of asymptomatic CAD among OLT recipients with cardiovascular risk factors through systematic use of CCT. 2) the proportion of CCT positive patients in whom CAD was confirmed by means of coronary angiography and followed by coronary revascularization. 3) the drop out from transplantation list due to untreatable CAD. 4) 1-year post OLT cardiac death after coronary revascularization.

Methods

All OLT candidates referred to the Transplant Centre in Udine between 2020-2024 who underwent cardiovascular screening through CCT were enrolled. Clinical data regarding the first visit, listing, transplantation and follow-up until the last outpatient visit were retrospectively collected.

Results

37/120 OLT candidates with risk factors for CAD underwent CCT (mean age 60y, 75% male, mean MELD 13). CCT was abnormal in 10/37 (27%) and coronary angiography confirmed critical CAD in 3/10 (30%), all of whom underwent coronary revascularization. There were no cases of 1-year post OLT cardiac death and none dropped out from the list because of untreatable CAD.

Conclusions

CCT abnormalities were detected in near 30% of OLT candidates with risk factors for CAD. However, CCT overestimated the presence of clinically relevant CAD compared to coronary angiography. Coronary revascularization in patients presenting clinically relevant CAD does not preclude their access to OLT and was not associated with an increased 1-year post OLT mortality.

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冠状动脉CT扫描筛查无症状冠状动脉疾病肝移植候选者

背景：冠状动脉疾病（CAD）是肝移植（OLT）受者非移植物相关性死亡的最常见原因。缺乏证据支持系统地使用冠状动脉CT扫描（CCT）来评估有心血管危险因素的OLT候选人中CAD的存在。目的：通过系统使用CCT评估有心血管危险因素的OLT受者无症状CAD的患病率。2)经冠状动脉造影确诊冠心病并行冠状动脉血运重建术的CCT阳性患者比例。3)因CAD无法治愈而退出移植名单。4)冠脉血运重建术后心脏死亡1年。方法纳入所有在2020-2024年间通过CCT进行心血管筛查的乌迪内移植中心的OLT候选人。回顾性收集首次就诊、列单、移植及随访至最后一次门诊的临床资料。结果：有CAD危险因素的OLT患者中有37/120接受了CCT（平均年龄60岁，75%为男性，平均MELD为13）。10/37例（27%）CCT异常，3/10例（30%）冠脉造影证实冠心病危重，均行冠脉重建术。没有一例OLT后1年心脏死亡病例，也没有一例因无法治疗的CAD而退出名单。结论在有冠心病危险因素的OLT患者中，有近30%的患者存在scct异常。然而，与冠状动脉造影相比，CCT高估了临床相关CAD的存在。临床相关冠心病患者的冠状动脉血管重建术并不妨碍他们接受OLT治疗，也与OLT治疗后1年死亡率的增加无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.