TY - JOUR
T1 - Cardiac risk stratification of the liver transplant candidate
T2 - A comprehensive review
AU - Nagraj, Sanjana
AU - Peppas, Spyros
AU - Guerrero, Maria Gabriela Rubianes
AU - Kokkinidis, Damianos G.
AU - Contreras-Yametti, Felipe I.
AU - Murthy, Sandhya
AU - Jorde, Ulrich P.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2022/7/18
Y1 - 2022/7/18
N2 - Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.
AB - Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.
KW - Cardiovascular diagnostic techniques
KW - Cardiovascular diseases
KW - Cardiovascular risk
KW - End stage liver disease
KW - Liver cirrhosis
KW - Liver transplantation
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UR - http://www.scopus.com/inward/citedby.url?scp=85136033650&partnerID=8YFLogxK
U2 - 10.5500/wjt.v12.i7.142
DO - 10.5500/wjt.v12.i7.142
M3 - Review article
AN - SCOPUS:85136033650
SN - 2220-3230
VL - 12
SP - 142
EP - 156
JO - World Journal of Transplantation
JF - World Journal of Transplantation
IS - 7
ER -