Appraising cardiac dysfunction in liver transplantation: an ongoing challenge

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• End-stage liver disease (ESLD) is a multisystemic condition with significant cardiac involvement.
• Cardiac dysfunction is common in ESLD, often coexisting with cirrhosis etiology and exacerbated by the disease itself.
• Liver transplantation, while curative for ESLD, introduces substantial cardiac risks, both short- and long-term.

Purpose of the Study:

• To comprehensively review the spectrum of cardiac dysfunction in ESLD.
• To critically evaluate the limitations in current methods for assessing cardiac function and structure in ESLD.
• To propose a novel approach for studying cardiac dysfunction in liver transplant candidates.

Main Methods:

• Literature review focusing on cardiac dysfunction in ESLD and liver transplantation.
• Analysis of current societal recommendations and their methodological constraints.
• Development of a hypothetical framework for future research.

Main Results:

• ESLD presents a complex spectrum of cardiac dysfunction, intertwined with liver disease progression and treatment.
• Existing guidelines and assessment tools are insufficient for precise phenotypic characterization of cardiac dysfunction in ESLD.
• Significant gaps exist in understanding and managing cardiac morbidity in liver transplant recipients.

Conclusions:

• Accurate phenotyping of cardiac dysfunction in ESLD is crucial for prognosis and therapy but is currently hindered by methodological limitations.
• A refined, hypothetical approach is proposed to facilitate robust study design for cardiac dysfunction in liver transplant candidates.
• Further research is needed to improve the assessment and management of cardiac complications in ESLD and post-liver transplantation.