CAD-LT Score and Outcomes after Liver Transplantation: Insights from a Middle Eastern Cohort

Background Cardiovascular disease remains a major cause of morbidity and mortality following liver transplantation (LT). The CAD-LT score has been proposed as pre-transplant risk stratification tool for coronary artery disease (CAD) in LT candidates. However, it is predictive value has not been validated in Middle Eastern populations. Aim To validate CAD-LT score and evaluate its association with post-liver transplant outcomes including cardiac events, patient and graft survival Methodology A retrospective analysis of 725 LT adult recipients transplanted between 2020 and 2024 was performed. Data included demographics, comorbidities, pre/post-transplant cardiac assessments (echocardiography, cardiac catheterization), and CAD-LT scores. Patients were stratified into high-, intermediate-, or low-risk groups; [HR, IR, LR]. Outcomes included cardiac events (myocardial infarction, cardiac death, and rhythm disorder), patient and graft survival. Statistical analyses used chi-square tests, the Wilcoxon test, and Kaplan-Meier survival curves. Results The median age was 57.05 years, and 84.4% were male. The most common comorbidities were diabetes (47.66%), hypertension (33.61%), and obesity (33.88%). Based on the CAD-LT score, 41.7% of patients were classified as high risk, while 58.3% were categorized as intermediate- or low risk. Cardiac interventions were significantly more frequent in high-risk patients than in low/intermediate risk patients (9.3% vs 0.47%, p<0.0001). However, four-year patient survival (85% vs. 84%, p = 0.91) and graft survival (85% vs. 83%, p = 0.69) did not differ significantly between risk groups. A total of 12 cardiac-related deaths occurred, with no significant difference between the groups (50% vs. 50%, p = 0.544), while atrial fibrillation occurred more frequently among high-risk patients (1.98% vs. 0.24%, p=0.016%). Conclusion This is the first study to validate CAD-LT in Middle Eastern LT recipients. While high-risk patients required more pre-transplant cardiac interventions, long-term patient and graft survival were comparable across groups, highlighting the benefit of systematic cardiovascular screening and early intervention.