Cardiac Risk Assessment in Liver Transplant Candidates: Current Controversies and Future Directions

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Liver transplantation (LT) recipients face significant cardiovascular comorbidities, with cardiac complications being a leading cause of mortality.
• End-stage liver disease (ESLD) uniquely impacts cardiovascular physiology, complicating risk assessment.
• Current pre-transplant cardiac screening methods are insufficient for accurately identifying risks in ESLD patients.

Purpose of the Study:

• To define cardiac events in LT.
• To evaluate current evidence for cardiac risk assessment in LT candidates.
• To propose an evidence-based algorithm for cardiac risk stratification in LT.

Main Methods:

• Literature review of current evidence on cardiac risk assessment in LT candidates.
• Analysis of limitations in existing diagnostic testing modalities for ESLD patients.
• Development of a proposed evidence-based testing algorithm.

Main Results:

• Cardiac complications are the primary cause of morbidity and mortality post-LT.
• Existing screening tools have limitations in detecting cardiac issues in ESLD patients.
• Wide variation exists in cardiac risk assessment practices among transplant centers.

Conclusions:

• Improved pre-transplant cardiac risk stratification is essential for better LT outcomes.
• An evidence-based algorithm is needed to standardize and enhance cardiac evaluation.
• Further research is required to address knowledge gaps and controversies in cardiac risk assessment for LT.