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Ischemic Heart Disease in Liver Transplant Candidates With High Bleeding Risk: Any Way Out?
Chiara Del Carlo1, Lorenza Santoni1, Iacopo Fabiani2
1Department of Clinical and Experimental Medicine, University of Pisa, Italy.
JACC. Case Reports
|May 23, 2025
Summary
Managing coronary artery disease (CAD) in liver transplant candidates is complex. Careful balancing of bleeding and clotting risks is essential for successful outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) management poses challenges in liver transplant candidates due to dual risks of bleeding and thrombosis.
- Antiplatelet therapy, crucial for preventing thrombotic events, can elevate hemorrhagic risks during hepatic surgery.
Observation:
- A 71-year-old woman with end-stage liver disease (ESLD) presented with significant CAD requiring pretransplantation evaluation.
- A multidisciplinary team opted for invasive CAD treatment, implementing precautions to mitigate bleeding risks.
Findings:
- Managing CAD in ESLD patients is intricate due to complex comorbidities and high perioperative risks.
- Active screening for CAD in ESLD patients awaiting liver transplantation is recommended.
Implications:
- Further research is needed to establish optimal CAD treatment strategies for this specific patient population.
- Multidisciplinary care is vital for optimizing outcomes in liver transplant candidates with CAD.
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