Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

Lisa B. VanWagner, Matthew E. Harinstein, James R. Runo, Christopher Darling, Marina Serper, Shelley Hall, Jon A. Kobashigawa, Laura L. Hammel*

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis, thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. Therefore, this review, assembled by a group of multidisciplinary experts in the field and endorsed by the American Society of Transplantation Liver and Intestine and Thoracic and Critical Care Communities of Practice, provides a critical assessment of the diagnosis of cardiac and pulmonary vascular disease and interventions aimed at managing these conditions in LT candidates. Key points and practice-based recommendations for the diagnosis and management of cardiac and pulmonary vascular disease in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

Original languageEnglish (US)
Pages (from-to)30-42
Number of pages13
JournalAmerican Journal of Transplantation
Volume18
Issue number1
DOIs
StatePublished - Jan 2018

Keywords

  • cardiovascular disease
  • clinical research/practice
  • heart disease
  • liver disease
  • liver transplantation/hepatology
  • risk assessment/risk stratification

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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