{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:50:44Z","timestamp":1791345044651,"version":"4.3.1"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiovascular (CV) disease is a leading cause of morbidity and mortality after liver transplantation (LT). Coronary computed tomography angiography (CCTA) has increasingly replaced stress testing (ST) for CV risk assessment in LT candidates with intermediate\u2010to\u2010high CV risk, although comparative evidence remains limited. The primary endpoint was the incidence of post\u2010LT major adverse cardiovascular events (MACE) by CV screening modality; the secondary endpoint was to identify predictors of MACE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective study included 506 patients who underwent LT between 2018 and 2023. According to CV screening modality, patients were stratified into three groups: no test (low CV risk), ST, or CCTA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 506 LT recipients, 358 (70.8%) presented low CV risk, 57 (11.3%) underwent ST, and 91 (18.0%) CCTA. Compared with ST, CCTA led to higher rates of coronary angiography (14%\u00a0vs. 31.9%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011) and revascularization (0%\u00a0vs. 15.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). After a median follow\u2010up of 2.5 years [IQR 1.5\u20133.9], MACE occurred more frequently in CCTA (18.4%) and ST (14%) groups than in low\u2010risk group (9%) (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.041), while no significant difference was observed between CCTA and ST groups (14%\u00a0vs. 18.4%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.501). In univariate and multivariate Cox\u2010regression analysis, only age and family history of coronary artery disease were independent predictors of MACE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CCTA and ST resulted in comparable post\u2010LT CV outcomes. Although CCTA was associated with a higher number of pre\u2010LT coronary interventions, it was not associated with a lower incidence of MACE, underscoring the need to refine CV risk stratification protocols in LT candidates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practitioner Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Currently, there are no international guidelines for cardiovascular screening procedures in LT candidates, leading to variability in practice across different centers and countries. Coronary computed tomography angiography (CCTA) has emerged as a more accurate method than stress testing (ST) in detecting coronary artery disease (CAD) in patients with end\u2010stage liver disease.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In the present study, all pre\u2010transplant coronary revascularizations were performed in patients screened with CCTA, while none occurred in the ST group. Despite this, the incidence of post\u2010LT major adverse cardiovascular events (MACE) was similar between groups. In our cohort, revascularizations prompted by CCTA did not significantly reduce post\u2010LT MACE rate. Age and family history of CAD were the only independent predictors of MACE.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Our results underscore the need to refine cardiovascular risk stratification protocols for LT candidates.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70680","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:30:26Z","timestamp":1789464626000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Preoperative Cardiac Screening Modality on Cardiovascular Outcomes After Liver Transplantation"],"prefix":"10.1111","volume":"40","author":[{"given":"Giuseppe","family":"Esposito","sequence":"first","affiliation":[{"name":"Hepato\u2010Pancreato\u2010Biliary Surgery and Liver Transplantation Unit Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"},{"name":"Clinical and Experimental Medicine PhD Program, Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Manicardi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Bonini","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Di Sandro","sequence":"additional","affiliation":[{"name":"Hepato\u2010Pancreato\u2010Biliary Surgery and Liver Transplantation Unit Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Vitolo","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Di Benedetto","sequence":"additional","affiliation":[{"name":"Hepato\u2010Pancreato\u2010Biliary Surgery and Liver Transplantation Unit Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Piero","family":"Guerrini","sequence":"additional","affiliation":[{"name":"Hepato\u2010Pancreato\u2010Biliary Surgery and Liver Transplantation Unit Policlinico Di Modena University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.01.008"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2024.08.021"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.05.008"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24128"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805971"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2022.09.003"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2022.07.002"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15926"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v12.i7.142"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/4081525"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915922"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001104"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01440-5"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.03.071"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.533471"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2013.09.035"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2011.05.009"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000215"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.114.002179"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/2012.jama.11274"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14092"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181e15da8"},{"key":"e_1_2_13_24_1","first-page":"S47","article-title":"An 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