Impact of Pre-Liver Transplant Cardiovascular Disease Risk Assessment Standardization on Resource Utilization and Recipient Selection
1Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, 2Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO, 3Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
Meeting: 2020 American Transplant Congress
Abstract number: C-166
Keywords: Arteriosclerosis, Liver, Liver transplantation, Risk factors
Session Information
Session Name: Poster Session C: Liver: Recipient Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Cardiovascular disease (CVD) risk assessment (RA) prior to liver transplantation (LT) is a critical aspect of recipient selection, however data on optimal testing is limited. The objective of this study was to assess the impact of CVD RA protocol standardization on resource utilization and recipient selection.
*Methods: Retrospective review of all patients evaluated for LT at a single center over a two-year period was performed. Patients were divided into two cohorts: non-standardized protocol (NSP) (1/1/16-12/31/16) and standardized protocol (SP) (1/1/17-12/31/17). Patients evaluated for re-transplantation or acute liver failure were excluded. In the NSP, patients age >50 underwent screening dobutamine stress echo (DSE) with subsequent testing per provider assessment and LT selection committee input. In the SP, patients age >50 or <50 with greater than or equal to 1 traditional CVD risk factor (RF) underwent DSE. Patients with an abnormal DSE or greater than or equal to 2 CVD RF regardless of DSE underwent coronary angiography (CA). CVD RF included hypertension, hyperlipidemia, diabetes mellitus, smoking, obesity, family history of coronary artery disease (CAD), peripheral vascular disease and advanced age (> 60 years old).
*Results: A total of 369 patients underwent LT evaluation: 209 patients in the NSP and 160 patients in the SP. There was no difference in baseline characteristics or CVD RF, however there was more preexisting CAD in the SP vs NSP cohort (6.3% vs 1.9%, p=0.03). While DSE usage was similar in the SP vs NSP (65.0%, vs 70.5%, p=0.26), SP used more CA (18.1% vs 9.2%, p=0.01) but found the same amount of CAD (7.2% vs 12.5%, p=0.09). In the SP less patients were declined (50% vs 61.4%, p=0.03) but a similar number were approved for listing (35.6% vs 29.5%, p= 0.21). Approved patients were more likely than declined patients to have undergone DSE (75.4% vs 57.5%, p=0.03) and CA (31.6% vs 11.3%, p=0.003).
*Conclusions: Introducing a SP for CVD RA utilizing DSE and CA increased resource utilization without improving CAD detection, though fewer patients were declined transplant listing. The inability to discover more CAD with additional testing highlights the challenge of assessing CV risk in LT candidates. Further studies warrant focus on novel CVD RA approaches such as CT coronary angiography and linkage of pre-LT CVD RA to post-LT outcomes.
To cite this abstract in AMA style:
Rice J, Hughes D, Burton JR, Pomfret ED, Pomposelli JJ, Ambardekar AV, Kriss M. Impact of Pre-Liver Transplant Cardiovascular Disease Risk Assessment Standardization on Resource Utilization and Recipient Selection [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-pre-liver-transplant-cardiovascular-disease-risk-assessment-standardization-on-resource-utilization-and-recipient-selection/. Accessed May 14, 2025.« Back to 2020 American Transplant Congress