Preoperative cardiac assessment in liver transplant candidates

Area of Science:

• Transplant Surgery
• Cardiology
• Hepatology

Background:

• Increasing incidence of cardiac diseases in liver transplant (LT) recipients.
• Lack of consensus in clinical practice guidelines for cardiovascular screening and risk stratification in LT candidates.
• Growing complexity of LT candidates due to new indications, older age, and cirrhosis complications.

Purpose of the Study:

• To define an appropriate and rational stepwise algorithm for preoperative cardiovascular assessment of liver transplant candidates.
• To address the challenges posed by increasing cardiovascular comorbidities in the LT population.
• To optimize the selection of suitable candidates for liver transplantation.

Main Methods:

• Review of common "pillars" in cardiovascular screening: electrocardiography, baseline echocardiography, and functional assessment.
• Discussion of the limitations and relevance of noninvasive stress tests.
• Exploration of noninvasive imaging and novel stress imaging techniques for risk stratification.
• Focus on defining the "high-risk" candidate.

Main Results:

• Current cardiovascular screening protocols for LT candidates lack universal consensus.
• Noninvasive stress tests have intrinsic limitations, necessitating careful interpretation.
• A stepwise approach integrating various assessment modalities is crucial for identifying high-risk individuals.
• The definition of a "high-risk" candidate requires ongoing refinement.

Conclusions:

• A rational, stepwise algorithm is needed for preoperative cardiovascular assessment in liver transplant candidates.
• Effective risk stratification is essential for judicious allocation of limited liver grafts.
• Optimizing candidate selection maximizes the potential for successful LT outcomes.
• Further research into advanced noninvasive imaging may enhance risk assessment accuracy.