Detection of coronary artery calcifications with low-dose thoracic computed tomography and cardiovascular events in liver transplant recipients.

INTRODUCTION: Low-dose computed tomography (LDCT) is useful for lung cancer screening in liver transplant recipients (LTR). It could also be useful for the detection of coronary artery calcifications (CAC) and for predicting the risk of adverse cardiovascular events (ACE). The aim of this study was to evaluate whether LDCT performed for post-transplant lung cancer screening can identify CAC burden and predict the development of ACEs in LTR. PATIENTS AND METHODS: 124 LTR and 485 matched controls were included. Controls were matched for age, sex, smoking history, and presence of emphysema. CAC was assessed on baseline LDCT using a semiquantitative score (0-12); scores ≥ 7 classified as severe. RESULTS: LTRs exhibited a higher prevalence of arterial hypertension, diabetes mellitus and hypercholesterolemia than controls. LTRs also had a greater proportion of severe CAC (26.2% vs. 9.2%, p < 0.0001). Liver transplantation, arterial hypertension, and age ≥ 60 years were independently associated with severe CAC. Among LTRs, severe CAC was associated with lower survival. During follow-up, LTRs experienced a higher incidence of ACEs (10.7% vs. 3.7%, p = 0.02). Severe CAC, age above 60 years, and hypercolesterolemia were independently associated with an increased risk of ACEs, whereas liver transplantation itself was not. CONCLUSION: LDCT enables the detection of severe CAC in LTRs, which is associated with an increased risk of ACEs and reduced survival, thus supporting the use of LDCT both for lung cancer screening and for cardiovascular risk stratification in LTRs who smoke with a low radiation exposure and without the need of contrast medium.