Pre-Operative Cardiovascular Testing before Liver Transplantation

Area of Science:

• Cardiology
• Hepatology
• Transplant Medicine

Background:

• End-stage liver disease (ESLD) and coronary artery disease (CAD) share risk factors, necessitating cardiovascular evaluation before liver transplantation.
• Current pre-transplant cardiovascular testing practices for CAD lack standardized guidelines and exhibit significant variability.
• Understanding the relationship between pre-transplant cardiac testing and post-transplant outcomes is crucial for patient management.

Purpose of the Study:

• To characterize the current practices of pre-transplant cardiovascular testing in patients undergoing liver transplantation.
• To evaluate the association between pre-transplant cardiac testing modalities and post-transplant clinical outcomes.
• To identify potential areas for optimizing cardiovascular assessment in liver transplant recipients.

Main Methods:

• Retrospective review of 285 patients undergoing initial liver transplantation between January 2015 and March 2019.
• Analysis of electronic medical records for demographic data, clinical information, and cardiovascular testing results.
• Assessment of post-transplant clinical outcomes, including mortality and major adverse cardiovascular events, over a mean follow-up of 2.4 years.

Main Results:

• Pre-transplant transthoracic echocardiogram (TTE) was performed in 96.1% of patients, with 6.6% showing abnormalities.
• Non-invasive ischemic testing was utilized in 68% of patients, including stress TTE (58%) and myocardial perfusion imaging (8%).
• Left heart catheterization in 6% of patients revealed abnormalities in 63%, leading to revascularization in 5 patients; overall post-transplant cardiovascular complications and deaths were infrequent.

Conclusions:

• Pre-transplant cardiovascular testing is widely implemented in liver transplant candidates.
• Post-transplant cardiovascular complications and mortality appear to be low in this cohort.
• Optimal strategies for cardiovascular testing and surveillance in liver transplant recipients require further investigation.