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Published on: August 2, 2024
Management of the liver transplant candidate with high cardiac risk: Multidisciplinary best practices and
Giulia Pagano1, Anoop N Koshy2, Ryan Chadha3
1Department of Hepatology, Hospital Clínic, Liver Transplant Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.
Insights
Cardiac comorbidities are increasingly common in liver transplant candidates due to rising rates of liver diseases and aging populations. This review offers guidance on managing heart conditions before and during liver transplantation.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Increasing prevalence of alcohol-associated and metabolic dysfunction-associated steatotic liver diseases.
- Aging patient demographic leading to a rise in cardiac comorbidities among liver transplant candidates.
- Cardiac comorbidities impact transplant eligibility, intraoperative management, and posttransplant outcomes.
Purpose of the Study:
- To review current evidence on managing cardiac comorbidities in liver transplant candidates.
- To provide recommendations for optimizing preoperative and intraoperative care.
- To improve and standardize clinical management of these complex patients.
Main Methods:
- Comprehensive literature review of recent evidence.
- Focus on coronary heart disease, valvular heart disease, arrhythmia, and cardiomyopathy.
- Analysis of preoperative and intraoperative management strategies.
Main Results:
- Significant need for evidence-based guidelines for cardiac comorbidity management in liver transplant recipients.
- Current management practices require optimization.
- Multidisciplinary approach is essential for effective care.
Conclusions:
- Standardized, evidence-based recommendations are needed for managing cardiac comorbidities in liver transplant candidates.
- Optimized perioperative cardiac care can improve transplant outcomes.
- Further research is warranted to address evidence gaps.
Abstract:
In a setting characterized by a growing prevalence of patients with alcohol-associated and metabolic dysfunction-associated steatotic liver diseases, coupled with an aging patient demographic, the incidence of cardiac comorbidities in liver transplant candidates is on the rise. These comorbidities not only pose barriers to transplant eligibility but also impact the intraoperative course and affect posttransplant outcomes. As such, there is a significant need to optimize the clinical management of these cardiac comorbidities. However, there is a scarcity of evidence regarding the best practices for managing cardiac comorbidities such as coronary and valvular heart diseases, arrhythmia, and cardiomyopathy in this population, both before and during transplant surgery. These conditions necessitate a coordinated and multidisciplinary approach to care. In this manuscript, we conduct a comprehensive review of the most recent evidence pertaining to the preoperative and intraoperative management of these cardiac comorbidities in liver transplant candidates. Our aim is to provide recommendations that improve and standardize their clinical care.
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