How can you calculate your risk of dying or being hospitalized for cardiovascular complications in the year following a liver transplant? There’s an app for that.
From experts at Northwestern University, a new application - available for download on the web and smartphone app stores - is the first of its kind to calculate risk scores specific to people receiving liver transplants. The new technology is called Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT). It is intended for use by people with liver disease between 18 and 75 being evaluated as candidates for liver transplantation.
"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," explained Northwestern’s Dr. Lisa VanWagner. A large amount of people - about one-third - undergoing liver transplants end up in the hospital with cardiovascular complications during the first year of their recovery. For this one-third of patients, they are subsequently less likely to survive than the remaining two-thirds. Overall, experts estimate that ten percent of liver transplant patients don’t survive the year following liver transplantation.
While a tough decision, VanWagner says that the risk score calculation would enable medical professionals to choose recipients most likely to survive the procedure. This way, doctors could “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.”
Those liver disease patients who were given high risk scores wouldn’t be immediately denied a donor organ; instead, additional “evaluation and consultation” would be conducted to address potential complications that could occur during the transplant procedure. CAR-OLT takes into account several different factors to calculate risk score, including age, sex, race, employment status, highest education achieved, cancer status, diabetes, heart failure, atrial fibrillation, pulmonary hypertension.
Previous methods of assessing risk of cardiovascular complications during liver transplant procedures were severely lacking credibility. The “revised cardiac risk index,” VanWagner said, is “no better at predicting cardiac risk in this population than flipping a coin” because it’s not specific to liver transplants.
Compared to other transplant procedures, liver transplantations are especially high-risk in the context of heart health. Three factors provide an explanation as to why:
- Blood flow changes related to end-stage liver disease that necessitates a transplant
- Blood volume changes during procedure
- Boosted adrenaline levels during procedure
Nearly seven thousand people undergo liver transplant procedures every year in the United States alone, and twice as many people are still waiting. The new one-year risk app, depending on the extent of its use, could greatly enhance the process of selection for transplant candidates.
The present study was published in the journal Hepatology.
Source: Northwestern University
