Diagnostic accuracy and cost-effectiveness of the CAR-OLT score in predicting cardiac risk for liver transplantation  

作　　者：Marco Biolato Luca Miele Alfonso W Avolio Giuseppe Marrone Antonio Liguori Francesco Galati Anna Petti Lidia Tomasello Daniela Pedicino Antonella Lombardo Alessia D'Aiello Maurizio Pompili Salvatore Agnes Antonio Gasbarrini Antonio Grieco 

机构地区：[1]Department of Medical and Surgical Sciences,Centro Malattie Apparato Digerente(CEMAD),Fondazione Policlinico Universitario Agostino Gemelli,Istituto di Ricerca e Cura a Carattere Scientifico(IRCCS),Rome 00168,Lazio,Italy [2]Department of Translational Medicine and Surgery,Catholic University of Sacred Heart,Rome 00168,Lazio,Italy [3]General Surgery and Liver Transplantation Unit,Fondazione Policlinico Universitario Agostino Gemelli,Istituto di Ricerca e Cura a Carattere Scientifico(IRCCS),Rome 00168,Lazio,Italy [4]Department of Cardiovascular Sciences,Fondazione Policlinico Universitario Agostino Gemelli,Istituto di Ricerca e Cura a Carattere Scientifico(IRCCS),Rome 00168,Lazio,Italy

出　　处：《World Journal of Transplantation》2025年第2期138-148,共11页世界移植杂志(英文)

摘　　要：BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.

关 键 词：TRANSPLANTATION Coronary artery disease Pharmacoeconomic LISTING Major adverse cardiovascular events 

分 类 号：R54[医药卫生—心血管疾病]