Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT) Score
Predicts major adverse cardiac events (MACE) within 30 days of orthotopic liver transplantation. Developed to guide pre-transplant cardiac evaluation and identify patients requiring intensive peri-operative cardiac management.
Score interpretation
CAR-OLT 0-1 -- low cardiac risk for liver transplantation
→ Standard pre-transplant cardiac evaluation: 12-lead ECG; echocardiogram (LV function, pulmonary pressure, portopulmonary hypertension screening); no additional stress testing required in low-risk patients; cardiology clearance with standard pre-operative protocol; proceed to transplant listing; post-transplant cardiac monitoring per standard protocol.
CAR-OLT 2-3 -- intermediate cardiac risk; additional evaluation before transplant
→ Non-invasive stress testing: dobutamine stress echocardiography (preferred -- adenosine MPI unreliable in liver disease due to systemic vasodilation); cardiac MRI if echo suboptimal; coronary CT angiography if intermediate stress test; right heart catheterisation if portopulmonary hypertension suspected (echo PASP > 45 mmHg); multidisciplinary transplant-cardiology team review; optimise medical therapy pre-transplant: beta-blocker, statin; consider coronary revascularisation if significant CAD identified (PCI or CABG pre-transplant).
CAR-OLT >= 4 -- high cardiac risk; may affect transplant eligibility; intensive evaluation required
→ Formal cardiology-hepatology MDT; invasive coronary angiography if CAD history or significant positive stress test; portopulmonary hypertension treatment if mPAP > 35 mmHg: ambrisentan, sildenafil (target mPAP < 35 mmHg before listing); cardiac resynchronisation or ICD if HF with EF <= 35%; revascularisation before transplant if haemodynamically significant CAD; intra-operative invasive haemodynamic monitoring (PA catheter or TOE); post-operative CCU monitoring; continuous troponin monitoring first 48 hours; cardiogenic shock protocol on standby; consider LVAD as bridge if severe HF; reassess transplant eligibility if MACE risk prohibitive.
Interpretation bands for the CAR-OLT. Apply clinical judgement and local guidance.
References
- Krowka MJ et al. Pulmonary circulatory complications of portal hypertension. Clin Liver Dis. 2014;18(2):443-462.
- Lentine KL et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates. J Am Coll Cardiol. 2012;60(5):434-480.
Related
Curated clinical cross-links plus same-class fallbacks.
- POSSUM Score for Surgical Morbidity and Mortality · Perioperative Risk
- SORT (Surgical Outcome Risk Tool) · Perioperative Risk
- Revised Cardiac Risk Index (RCRI / Lee Index) · Perioperative Risk
- ASA Physical Status Classification · Perioperative Risk
- Gupta Perioperative Risk for MI or Cardiac Arrest (MICA) · Perioperative Risk
- SORT — Surgical Outcome Risk Tool · Perioperative Risk
- Atorvastatin (CKD Cardiovascular Risk) · Cardiovascular Risk in CKD
- Icosapent Ethyl (Omega-3 — Cardiovascular Risk Reduction) · Omega-3 Fatty Acid (Purified EPA — Eicosapentaenoic Acid Ethyl Ester)
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Mavacamten · Cardiac myosin inhibitor
- Tenecteplase · Cardiovascular Emergency
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.