Related Experiment Video
Updated: Mar 11, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Evaluation of coronary artery disease in potential liver transplant recipients
Brian J Hogan1, Enoka Gonsalkorala1, Michael A Heneghan1
1Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, UK.
Insights
Liver transplant recipients face cardiac risks. A "quadruple assessment" approach, including cardiac testing, helps detect and prevent complications, improving patient survival after liver transplantation.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Liver transplantation (LT) survival rates have improved.
- Cardiac disease is the primary cause of early mortality post-LT.
- Coronary artery disease (CAD) prevalence is rising in LT candidates, particularly those with nonalcoholic fatty liver disease.
Purpose of the Study:
- To propose a comprehensive "quadruple assessment" strategy for evaluating LT recipients.
- To identify and mitigate cardiac complications in liver transplant candidates.
- To enhance patient outcomes and survival following liver transplantation.
Main Methods:
- A quadruple assessment paradigm including: history, examination, ECG; transthoracic echocardiogram; functional testing (e.g., cardiopulmonary exercise testing); and direct CAD assessment.
- Utilizing functional testing to predict post-transplant complications.
- Integrating cardiac risk assessment into the pre-transplant evaluation process.
Main Results:
- The quadruple assessment aims to maximize the detection and prevention of CAD-related complications.
- Functional testing independently predicts post-transplant complications, irrespective of existing cardiovascular disease.
- This comprehensive approach is crucial for managing cardiac risks in LT candidates.
Conclusions:
- A structured quadruple assessment is vital for evaluating cardiac function in liver transplant recipients.
- Early detection and management of cardiac disease, especially CAD, are critical for improving post-LT outcomes.
- This strategy enhances the ability to predict and prevent adverse cardiac events, thereby increasing transplant success.
Abstract:
Improvements in the management of patients undergoing liver transplantation (LT) have resulted in a significant increase in survival in recent years. Cardiac disease is now the leading cause of early mortality, and the stress of major surgery, hemodynamic shifts, and the possibilities of hemorrhage or reperfusion syndrome require the recipient to have good baseline cardiac function. The prevalence of coronary artery disease (CAD) is increasing in LT candidates, especially in those with nonalcoholic fatty liver disease. In assessing LT recipients, we suggest a management paradigm of "quadruple assessment" to include (1) history, examination, and electrocardiogram; (2) transthoracic echocardiogram; (3) functional testing; and (4) where appropriate, direct assessment of CAD. The added value of functional testing, such as cardiopulmonary exercise testing, has been shown to be able to predict posttransplant complications independently of the presence of CV disease. This approach gives the assessment team the greatest chance of detecting and preventing complications related to CAD. Liver Transplantation 23 386-395 2017 AASLD.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:27Coronary Artery Disease V: Interprofessional Care