Low Yield of Routine Pre-Operative Coronary CT Angiography in Patients Evaluated for Liver Transplantation
Although coronary revascularization prior to non-cardiac surgery has not been shown to reduce the risk of cardiac events, pre-operative noninvasive screening for obstructive coronary artery disease (CAD) is commonly performed. Such testing is even more likely to be performed among patients who are candidates for organ transplantation. The rationale for such testing in candidates for organ transplantation include the need to determine (1) the peri-operative risk, and (2) if the patient's cardiovascular risk is high enough that organ transplantation would be futile and an inappropriate use of a scarce organ.1 While screening for obstructive CAD in patients with end stage renal disease evaluated for kidney transplantation seems reasonable given the high prevalence of atherosclerosis and cardiovascular risk in these patients, there is intense debate of whether such approach should also be considered among patients with end stage liver disease (ESLD) in whom there is a generally much lower frequency of CAD, at least based on relatively small retrospective reports.2-6
- Received July 31, 2014.
- Accepted August 1, 2014.