The liver transplant recipient with cardiac disease

Liver transplantation is a stressful condition for the cardiovascular system of patients with advanced hepatic disease. The underlying hemodynamic and cardiac status of patients with cirrhosis is crucial to determine which patients should became recipients. Generally preoperative cardiovascular testing is performed on potential candidates who are more than 45 years old, or have diabetes mellitus, or peripheral vascular disease, or more than two standard cardiac risk factors. Recent data suggest that the prevalence of coronary artery disease among patients with cirrhosis is much greater than previously believed; it likely mirrors or exceeds the prevalence rate in the healthy population. The morbidity and mortality of patients with coronary artery disease who undergo orthotopic liver transplantation (OLT) without treatment are unacceptably high. In conclusion, accurate preoperative cardiac evaluation according to the new American Heart Association & American College of Cardiology should lead to detect and treat coronary artery disease before liver transplantation. In case of alcohol-related cardiomyopathy, portopulmonary hypertension, and hypertrophic cardiomyopathy, there should be a case-by-case discussion by the hepatologist and cardiologist to consider the patient for liver transplantation. No robust data are available on the impact of decompensated dilated heart failure in this setting. If a recipient with cardiac disease is scheduled for OLT, we strongly suggest advanced intra- and postoperative hemodynamic monitoring plus transesophageal echocardiography.