Abstract：
Liver transplantation (LT) is the second most performed solid organ transplant. Coronary artery disease (CAD) is a critical consideration for LT candidacy, particularly in patients with known CAD or risk factors, including metabolic dysfunction associated with steatotic liver disease. The presence of severe CAD may exclude patients from LT; therefore, precise preoperative evaluation and interventions are necessary to achieve transplant candidacy. Cardiovascular complications represent the earliest nongraft-related cause of death post-transplantation. Timely intervention to reduce cardiovascular events depends on adequate CAD screening. Coronary disease screening in end-stage liver disease is challenging because standard noninvasive CAD screening tests have low sensitivity due to hyperdynamic state and vasodilatation. As a result, there is overuse of invasive coronary angiography to exclude severe CAD. Coronary artery calcium scoring using a computed tomography scan is a tool for the prediction of cardiovascular events, and can be used to achieve risk stratification in LT candidates. Recent literature shows that qualitative assessment on both noncontrast- and contrast-enhanced chest computed tomography can be used instead of calcium score to assess the presence of coronary calcium. With increasing prevalence, protocols to address CAD in LT candidates must be reconsidered. Percutaneous coronary intervention could allow a shorter duration of dual-antiplatelet therapy in simple lesions, with safer perioperative outcomes. Hybrid coronary revascularization is an option for high-risk LT candidates with multivessel disease nonamenable to percutaneous coronary intervention. The objective of this review is to evaluate existing methods for preoperative cardiovascular risk stratification, and to describe interventions before surgery to optimize patient outcomes and reduce cardiovascular event risk.
摘要：
肝移植（LT）是第二大的实体器官移植。冠状动脉疾病（CAD）是LT候选人的关键考虑因素，特别是在已知CAD或危险因素的患者中，包括与脂肪变性肝病相关的代谢功能障碍。严重CAD的存在可能将患者排除在LT之外；因此，精确的术前评估和干预是实现移植候选的必要条件.心血管并发症是移植后死亡的最早非移植物相关原因。及时干预以减少心血管事件取决于充分的CAD筛查。终末期肝病的冠状动脉疾病筛查具有挑战性，因为标准的非侵入性CAD筛查测试由于高动力状态和血管扩张而具有低敏感性。因此,过度使用侵入性冠状动脉造影排除严重CAD.使用计算机断层扫描进行冠状动脉钙评分是预测心血管事件的工具，并可用于实现LT候选人的风险分层。最近的文献表明，可以使用非对比和对比增强胸部计算机断层扫描的定性评估来代替钙评分来评估冠状动脉钙的存在。随着患病率的增加，必须重新考虑在LT候选人中解决CAD的协议。经皮冠状动脉介入治疗可以在简单病变中缩短双联抗血小板治疗的持续时间，围手术期结果更安全。混合冠状动脉血运重建是不适合经皮冠状动脉介入治疗的多支血管疾病的高风险LT候选人的选择。这篇综述的目的是评估现有的术前心血管危险分层方法，并描述术前干预措施以优化患者预后并降低心血管事件风险。
