June 2, 2025Liver TransplantationOpen Access

Abdominal aortic calcification on routine preoperative computed tomography—A novel cardiovascular risk prediction tool in liver transplant patients

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Why the study?

Cardiovascular disease is a leading cause of post-LT mortality, and whether routine pre-transplant CT abdominal aortic calcification could improve CV risk prediction was unknown.

Does high abdominal aortic calcification on routine pre-transplant CT predict cardiovascular events and mortality in liver transplant patients?

Structured PICO

Does high abdominal aortic calcification on routine pre-transplant CT predict cardiovascular events and mortality in liver transplant patients?

Population

318 patients undergoing liver transplantation between 2010 and 2018, among whom 81 had also undergone computed tomography coronary angiography.

Intervention

High abdominal aortic calcification (AAC) defined as a calcium score ≥500 on routine pre-transplant CT

Comparator

Absence of high AAC (calcium score <500)

Outcome

Moderate-to-severe coronary disease on CT coronary angiography, 30-day post-LT major adverse cardiovascular events (MACEs), and long-term mortalitycomposite

High abdominal aortic calcification on routine pre-transplant CT is a strong independent predictor of 30-day MACE and long-term mortality in liver transplant patients, improving cardiovascular risk prediction.

Implication

May support AAC on pre-LT CT for CV risk stratification; hypothesis-generating for MACE prediction, requiring prospective validation.

Abstract

Cardiovascular (CV) disease is a leading cause of postoperative mortality following liver transplantation (LT). The presence of abdominal aortic calcification (AAC) has been linked to CV events in the general population. We sought to investigate whether AAC on routine pre-transplant CT can improve the prediction of coronary artery disease, post-LT major adverse cardiovascular events (MACEs) or long-term mortality. Of 461 patients undergoing LT between 2010 and 2018, 318 were included in the analysis, among whom 81 had also undergone computed tomography coronary angiography. The extent of AAC was quantified with high AAC defined as a calcium score ≥500. High AAC was identified in 84/318 (26.4%) and demonstrated moderate correlation with coronary artery calcium score (CACS) ( r =0.52, p <0.001). Thirty-two MACE events occurred in 28 patients (8.8%) within 30 days. High AAC was a strong independent predictor of moderate-to-severe coronary disease on CT coronary angiography (OR 12.6, 95% CI 1.5-103.0, p =0.02). It was also associated with a significantly increased risk of 30-day MACE (OR 2.34, 95% CI 1.08-5.05, p =0.03) and long-term mortality (HR 2.45, 95% CI 1.18-5.06, p =0.02). Following multivariate analysis adjusting for pertinent CV risk factors, high AAC remained a strong independent predictor of MACE (OR 3.10, 95% CI 1.27-7.60, p =0.02). Addition of AAC to the Revised Cardiac Risk Index significantly improved model fit for predicting MACE outcomes ( p <0.01), while the absence of heavy AAC ruled out moderate-to-severe disease on CT coronary angiography with a negative predictive value of 97.0%. High AAC on routine CT scans was associated with a 3-fold increased risk of 30-day MACE post-LT and improved CV risk prediction compared to traditional indices. Quantification of AAC may offer a simple method of improving CV risk assessment in these patients.