Predicting heart events after liver transplant

The first app and score to determine the one-year risk of a liver transplant patient dying or being hospitalized for a heart attack or other cardiovascular complication has been developed by Northwestern Medicine scientists.
“Knowing the patient’s risk is critical to help prevent the frequent cardiac complications that accompany liver transplant surgery and to determine which patients are likely to survive the transplant,” said Dr. Lisa VanWagner, an assistant professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
Liver transplant surgery is among the highest-risk cardiac surgery. Unique blood flow changes occur in patients with end-stage liver disease. And during a liver transplant, massive changes in blood volume and adrenaline surges affect heart function.
“Identifying persons who are at highest risk may mean restricting transplantation so that we maximize the benefit of scarce donor organs to persons who have a lower risk of a cardiac event and are more likely to survive the stress of a liver transplant,” VanWagner said.
In those who are at higher risk, evaluation and consultation with a multidisciplinary team of physicians can help manage a wide array of cardiac conditions related to liver transplant patients.
The new app and method to establish risk is called the Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT). It’s intended for use in those ages 18 to 75 with liver disease who are undergoing evaluation for liver transplantation.
The app is both web-based (e.g., you can search the calculator and use it online) or you can download the app through a smartphone (iTunes or Google Play stores).
Prior to the new Northwestern risk-scoring method, physicians used several risk tools that had been developed in a non-liver transplant population. One such tool, the revised cardiac risk index, is no better at predicting cardiac risk in this population than flipping a coin (50 percent of the time the score predicts accurately, but 50 percent of the time it predicts inaccurately), VanWagner said.
The CAR-OLT method is thus the first liver transplant-specific risk tool for cardiac risk in liver transplant candidates.

Northwestern University
news.northwestern.edu/stories/2017/july/predicting-heart-events-after-liver-transplant/