TY - JOUR
T1 - Evaluation of recipients with significant comorbidity – Patients with cardiovascular disease
AU - Tsochatzis, Emmanuel A.
AU - Watt, Kymberly D.
AU - VanWagner, Lisa B.
AU - Verna, Elizabeth C.
AU - Berzigotti, Annalisa
N1 - Publisher Copyright:
© 2023 European Association for the Study of the Liver
PY - 2023/6
Y1 - 2023/6
N2 - Liver transplant(ation) (LT) is the most effective treatment for patients with decompensated liver disease. The increasing prevalence of obesity and type 2 diabetes and the growing number of patients with non-alcoholic fatty liver disease being evaluated for LT, have resulted in a greater proportion of LT candidates presenting with a higher risk of cardiovascular disease. As cardiovascular disease is a major cause of morbidity and mortality after LT, a thorough cardiovascular evaluation pre-LT is crucial. In this review, we discuss the latest evidence on the cardiovascular evaluation of LT candidates and we focus on the most prevalent conditions, namely ischaemic heart disease, atrial fibrillation and other arrhythmias, valvular heart disease, and cardiomyopathies. LT candidates undergo an electrocardiogram, a resting transthoracic echocardiography and an assessment of their cardiopulmonary functional ability as part of their standardised pre-LT work-up. Further diagnostic work-up is undertaken based on the results of the baseline evaluation and may include a coronary computed tomography angiography in patients with cardiovascular risk factors. The evaluation of potential LT candidates for cardiovascular disease requires a multidisciplinary approach, with input from anaesthetists, cardiologists, hepatologists and transplant surgeons.
AB - Liver transplant(ation) (LT) is the most effective treatment for patients with decompensated liver disease. The increasing prevalence of obesity and type 2 diabetes and the growing number of patients with non-alcoholic fatty liver disease being evaluated for LT, have resulted in a greater proportion of LT candidates presenting with a higher risk of cardiovascular disease. As cardiovascular disease is a major cause of morbidity and mortality after LT, a thorough cardiovascular evaluation pre-LT is crucial. In this review, we discuss the latest evidence on the cardiovascular evaluation of LT candidates and we focus on the most prevalent conditions, namely ischaemic heart disease, atrial fibrillation and other arrhythmias, valvular heart disease, and cardiomyopathies. LT candidates undergo an electrocardiogram, a resting transthoracic echocardiography and an assessment of their cardiopulmonary functional ability as part of their standardised pre-LT work-up. Further diagnostic work-up is undertaken based on the results of the baseline evaluation and may include a coronary computed tomography angiography in patients with cardiovascular risk factors. The evaluation of potential LT candidates for cardiovascular disease requires a multidisciplinary approach, with input from anaesthetists, cardiologists, hepatologists and transplant surgeons.
KW - MELD
KW - NAFLD
KW - cardiomyopathy
KW - cardiopulmonary reserve
KW - cirrhosis
KW - ischaemic heart disease
KW - liver transplantation
KW - type II diabetes
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U2 - 10.1016/j.jhep.2023.03.023
DO - 10.1016/j.jhep.2023.03.023
M3 - Review article
C2 - 37208096
AN - SCOPUS:85159188251
SN - 0168-8278
VL - 78
SP - 1089
EP - 1104
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 6
ER -