CCTA and ST resulted in comparable post-LT CV outcomes, and although CCTA was associated with a higher number of pre-LT coronary interventions, it was not associated with a lower incidence of MACE, underscoring the need to refine CV risk stratification protocols in LT candidates.
Among 506 liver transplant recipients, patients were stratified into three groups based on cardiovascular screening modality: no test (low CV risk), stress testing (ST), or coronary computed tomography angiography (CCTA).
CCTA led to significantly higher rates of coronary angiography and revascularization compared to stress testing.
Post-liver transplant MACE occurred more frequently in the CCTA and ST groups than in the low-risk group, but there was no significant difference between CCTA and ST groups.
Age and family history of coronary artery disease were the only independent predictors of post-transplant MACE.
Despite higher rates of pre-transplant revascularization prompted by CCTA, revascularizations did not significantly reduce post-liver transplant MACE rates.
There are currently no international guidelines for cardiovascular screening procedures in liver transplant candidates, leading to variability in practice across centers and countries.
This research examined whether the type of heart screening test given to liver transplant candidates affects their risk of having a major heart event (such as a heart attack or stroke) after transplantation. The study looked at 506 patients at a single center who received liver transplants between 2018 and 2023. Patients were divided into three groups: those considered low-risk who received no heart test, those who had a stress test (ST), and those who had a specialized CT scan of the heart's arteries (CCTA). The CT scan approach detected more blockages and led to more patients undergoing procedures to open clogged arteries before transplant, while no patients in the stress test group had such procedures. Despite the CT scan group having more pre-transplant heart procedures, the rate of serious heart events after transplantation was similar between the CT scan group (18.4%) and the stress test group (14%), with no statistically significant difference between them. Both intermediate-to-high risk groups had more heart events than the low-risk group (9%), as expected. When the researchers analyzed what factors predicted heart events after transplant, only older age and a family history of coronary artery disease mattered — not which type of screening test was used. This research suggests that simply switching from stress testing to CT-based heart screening does not appear to reduce patients' risk of heart problems after liver transplantation, even though CT scans identify more disease and lead to more interventions. This raises important questions about whether current approaches to heart risk assessment before liver transplant are optimally designed. The findings highlight a broader challenge: there are no international guidelines standardizing how to screen liver transplant candidates for heart disease, and the results suggest existing methods may need to be refined to better identify who will truly benefit from pre-transplant heart interventions.
Esposito G, Manicardi M, Bonini N, Di Sandro S, Vitolo M, Di Benedetto F, et al.. (2026). Impact of Preoperative Cardiac Screening Modality on Cardiovascular Outcomes After Liver Transplantation.. Clinical transplantation. https://doi.org/10.1111/ctr.70680