Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2025; 15(2): 99208
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.99208
Diagnostic accuracy and cost-effectiveness of the CAR-OLT score in predicting cardiac risk for liver transplantation
Marco Biolato, Luca Miele, Alfonso W Avolio, Giuseppe Marrone, Antonio Liguori, Francesco Galati, Anna Petti, Lidia Tomasello, Daniela Pedicino, Antonella Lombardo, Alessia D'Aiello, Maurizio Pompili, Salvatore Agnes, Antonio Gasbarrini, Antonio Grieco
Marco Biolato, Luca Miele, Giuseppe Marrone, Antonio Liguori, Maurizio Pompili, Antonio Gasbarrini, Antonio Grieco, Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
Marco Biolato, Luca Miele, Alfonso W Avolio, Giuseppe Marrone, Antonio Liguori, Francesco Galati, Anna Petti, Lidia Tomasello, Maurizio Pompili, Salvatore Agnes, Antonio Gasbarrini, Antonio Grieco, Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
Alfonso W Avolio, Salvatore Agnes, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
Daniela Pedicino, Antonella Lombardo, Alessia D'Aiello, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome 00168, Lazio, Italy
Author contributions: Biolato M, Miele L, and Avolio AW wrote the paper; Marrone G, Galati F, Petti A, and Tomasello L collected the data; Liguori A performed statistical analysis, Pedicino D, Lombardo A, D’Aiello A, Pompili M, Agnes S, Gasbarrini A, and Grieco A reviewed the manuscript for important intellectual content. All authors read and approved the final version.
Institutional review board statement: The study was approved by the ethics committee of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Lazio, Italy (resolution 4301, dated 8/7/2021).
Informed consent statement: Study participants provided informed written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, Centro Malattie Apparato Digerente (CEMAD), Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Largo A. Gemelli 8, Rome 00168, Lazio, Italy. marco.biolato@policlinicogemelli.it
Received: July 16, 2024
Revised: December 13, 2024
Accepted: January 14, 2025
Published online: June 18, 2025
Processing time: 219 Days and 13.9 Hours
Core Tip

Core Tip: The burden of cardiovascular risk factors and coronary artery disease among liver transplant (LT) candidates is increasing, but the optimal diagnostic cardiac work-up remains debated. The CAR-OLT score (available at www.carolt.us), based on twelve pre-transplant characteristics, predicts major adverse cardiovascular events one year after LT. In our population, a CAR-OLT score cut-off of ≤ 23 identifies low-risk patients who could directly proceed to LT listing without additional diagnostic tests. This approach could have avoided 87 stress tests and 13 coronary angiographies, saving an estimated €574.70 per patient for the Italian National Health System.