Pre-Transplant Coronary CT Angiography as a Predictor of Early Post-Liver Transplant Major Adverse Cardiac Events

Cardiovascular disease (CVD) has increased among liver transplant candidates and is the leading cause of early mortality (<1 year) post-transplant. Coronary computed tomography angiography (CCTA) has been increasingly utilized for pre-liver transplant CVD risk stratification; however, no study to date has demonstrated that coronary artery disease (CAD) diagnosed on pre-liver transplant CCTA is associated with early (<1 year) major adverse cardiac events (MACE). To investigate the association between CAD on pre-transplant CCTA and early post-liver transplant MACE we performed a single center, retrospective cohort study of adult liver transplant recipients who completed a CCTA during transplant evaluation from July 2018 to January 2024. Overall, 438 patients underwent CCTA with 276 undergoing liver transplantation. One-year post-transplant MACE-free survival was higher for those without CAD compared to those with any CAD (91.5% [85.6-97.7] vs. 80.6% [75.1-86.6], p = 0.04). However, this association did not persist when adjusting for age, sex, and diabetes (Adjusted HR 1.97, 95% CI: 0.84, 4.58). Our study demonstrates that CAD on pre-liver transplant CCTA increases the risk of early post-transplant MACE; however, further investigation is needed to confirm if the increase is due to CAD or underlying risk factors.