Galassi L, Spanevello M, Ravini ML, Mercandalli G. Cardiovascular risk stratification in liver transplant patients: Balancing clinical outcomes and resource allocation. World J Transplant 2025; 15(4): 105620 [DOI: 10.5500/wjt.v15.i4.105620]
Corresponding Author of This Article
Luca Galassi, MD, School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2025; 15(4): 105620 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.105620
Cardiovascular risk stratification in liver transplant patients: Balancing clinical outcomes and resource allocation
Luca Galassi, Martina Spanevello, Matteo Lino Ravini, Giulio Mercandalli
Luca Galassi, School of Vascular and Endovascular Surgery, University of Milan, Milan 20122, Lombardy, Italy
Martina Spanevello, Postgraduate School of Cardiac Surgery, University of Milan, Milan 20122, Lombardy, Italy
Matteo Lino Ravini, Giulio Mercandalli, Vascular and Endovascular Unit, IRCCS Galeazzi-Sant’Ambrogio, Milan 20157, Lombardy, Italy
Author contributions: Galassi L, Spanevello M, Ravini ML, and Mercandalli G contributed to this paper, designed the overall concept and outline, and wrote the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: Luca Galassi, Martina Spanevello, Matteo Lino Ravini, and Giulio Mercandalli have nothing to disclose.
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: Luca Galassi, MD, School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Received: January 30, 2025 Revised: March 19, 2025 Accepted: March 20, 2025 Published online: December 18, 2025 Processing time: 293 Days and 6.7 Hours
Abstract
Cardiovascular diseases are a leading cause of both short-term and long-term complications in patients who are candidates for liver transplantation. The increasing prevalence of cardiovascular risk (CVR) factors like hypertension, diabetes, and dyslipidemia in this population is linked to lower overall survival rates with an increased risk of major cardiovascular events during and after the procedure. However, while guidelines for CVR stratification exist, their clinical application remains inconsistent. A significant challenge is the high cost of comprehensive cardiovascular evaluation, which often involves advanced diagnostic tests, imaging, and multidisciplinary specialist consultations. This issue is especially challenging in public healthcare systems, where the financial burden of thorough cardiovascular examinations can stretch already limited resources. Given the increasing pressures on healthcare sustainability, it is essential to balance careful cardiovascular screening with the efficient use of resources. The rising costs highlight the need for evidence-based updates to practices that optimize patient outcomes while reducing the strain on the healthcare system. Tailored approaches should focus on both managing cardiovascular issues and considering the economic impact. Considering these challenges, adaptable protocols are needed to improve transplantation safety and efficacy while addressing the financial realities of public health systems and minimizing unnecessary costs.
Core Tip: Cardiovascular disease is a leading cause of complications in liver transplant candidates, yet risk assessment remains inconsistent due to high costs, especially in public healthcare systems. Balancing comprehensive screening with resource efficiency is crucial to improving outcomes while minimizing financial strain. Evidence-based, adaptable protocols are needed to enhance patient safety, optimize resource allocation, and ensure the long-term sustainability of healthcare systems.
