Predictive performance of CAR-OLT and CAD-LT scores for post-transplant adverse cardiovascular events in a large transplant center

Abstract

To the editor, Liver transplantation (LT) is a life-saving procedure for eligible patients with cirrhosis and/or liver malignancies, yet recipients remain at elevated risk for postoperative morbidity and mortality. Adverse cardiovascular events (CVE) are a key contributor and may be secondary to the underlying drivers of liver disease or associated comorbidities; cardiovascular health is further impacted by perioperative/postoperative stress and long-term effects of immunosuppression. [1] Standard procedures to minimize CVE risk include preoperative evaluation and optimization of cardiac risk. Recent efforts to stratify pretransplant cardiac risk have yielded scoring systems such as Cardiovascular Risk in OLT (CAR-OLT) [2] and Coronary Artery Disease in Liver Transplantation (CAD-LT). [3] Although CAR-OLT was developed specifically to predict 1-year post-LT CVE, CAD-LT was designed to predict significant CAD in the pre-LT setting, though it is plausible that this score could predict post-LT CVE as well. However, both scores were derived and validated in single-institution cohorts and require external validation.

Letter to the Editor: Suboptimal performance of CAR-OLT score to predict 1-year risk of cardiovascular events after liver transplantation

“…To the editor, We read Tang et al's paper [1] with great interest. They aimed to externally validate the Cardiovascular Risk in OLT (CAR-OLT) score [2] at the Liver Transplant (LT) Center of Pennsylvania.…”

Letter to the Editor: Is CAD-LT score as a predictor of coronary artery disease following liver transplantation?

“…A pivotal issue in the evaluation of candidates for liver transplantation (LT) is the adequate assessment of the presence of coronary artery disease (CAD), and in this regard, we read with interest the report by Tang and colleagues recently published in Liver Transplantation , where the performance of the CAD-LT score was retrospectively evaluated to assess the occurrence of post-LT cardiovascular events (CVEs) 1,2 . Although the CAD-LT score was originally devised to predict the presence of CAD before LT, they postulated that this score could also predict the occurrence of CVE following LT and found that it has a suboptimal discrimination performance in this setting 2,3 …”