Journal of Clinical and Experimental Hepatology · Oct 7, 2025

Coronary Computed Tomography Angiography (CTA) in the Diagnostic Triage of Patients Undergoing Liver Transplantation: A Long-term Outcome Study

By Lacaita PG, Finkenstedt A, Senoner T et al.

BACKGROUND: Cardiovascular risk stratification is crucial in patients with end-stage liver disease (ESLD) yet the optimal noninvasive strategy remains debated. Our study aimed to assess the prognostic value of coronary computed tomography angiography (CTA) and coronary artery calcium (CAC) in patients undergoing orthotopic liver transplantation (LT). METHODS: Patients with ESLD scheduled for LT referred to coronary CTA and the CACscore were included. The primary endpoint was all-cause mortality and the secondary endpoint was myocardial infarction (MI). RESULTS: Four hundred fifty-eight patients for pre-LT risk stratification were enrolled with 270 LT recipients (79.3% male; mean age 61 ± 8.5 years) finally being included. The mean follow-up was 7.5 ± 3.1 years, range: 2-13. Among 248 patients undergoing CTA, the majority (n = 173, 69.8%) had coronary artery disease (CAD) by CTA (Coronary Artery Disease-Reporting and Data System[CAD-RADS] 1-5), and n = 75 (30.2%) had no CAD. Stenosis severity was minimal-to-mild (<50%) in 112 (45.1%), intermediate (50-70%) in 44 (17.7%), and severe (>70%) in 17 (6.5%) patients. The all-cause mortality rate was 46 (17.0%) (n = 3 cardiovascular). Stenosis severity (CAD-RADS) was associated with mortality (Kaplan-Meier analysis, P < 0.001). On multivariate Cox regression, total plaque burden were associated with all-cause mortality (hazard ratio [HR]: 1.1, P = 0.034; 95% confidence interval [CI]: 0.649-0.983 and HR: 1.1, P = 0.029; 95% CI: 1.0-1.6), while the CAC score was not. Six acute myocardial infarctions (MIs, 3 ST-elevation MI [STEMI] and 3 non-STEMI) occurred, none of them (0%) in patients with CAD-RADS 0-1 and 100% CAD-RADS 2-4. CONCLUSION: Coronary CTA is a valuable tool for pre-LT cardiovascular risk assessment. Patients with no or minimal CAD on CTA have an excellent prognosis regarding survival. CLINICAL RELEVANCE STATEMENT: Coronary CTA enables refined risk stratification in patients undergoing liver transplantation by assessing stenosis severity and plaque burden.

doi.org/10.1016/j.jceh.2025.103200 Open access PubMed 41625213 Biomarkers