Cardiac Evaluation in Liver Transplant Candidates.

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Liver transplantation (LT) is the definitive treatment for end-stage liver disease.
• Cardiovascular disease, especially coronary artery disease (CAD), is increasingly prevalent in cirrhosis patients due to metabolic factors.
• Managing cardiovascular risks is vital for successful LT outcomes.

Purpose of the Study:

• To emphasize the critical need for comprehensive cardiovascular assessment in LT candidates.
• To guide risk stratification and cardiac investigation strategies for identifying CAD.
• To highlight the importance of managing pre-existing cardiovascular conditions before LT.

Main Methods:

• Risk stratification based on patient factors (age, sex, smoking, diabetes, hypertension, obesity, MASH cirrhosis).
• Tailoring cardiac investigations (high sensitivity vs. high specificity) based on identified risk levels.
• Evaluating for liver-specific (cirrhotic cardiomyopathy, portopulmonary hypertension) and unrelated cardiac conditions (arrhythmias, valvular disease).

Main Results:

• Specific risk factors significantly elevate the likelihood of CAD in cirrhosis patients.
• A tailored approach to cardiac investigations ensures accurate CAD detection.
• Cirrhosis patients present unique cardiac challenges beyond traditional risk factors.

Conclusions:

• Pre-transplant cardiovascular evaluation and risk management are essential for minimizing post-LT complications.
• A multidisciplinary team approach is strongly recommended for optimal patient care.
• Addressing cardiovascular health proactively enhances long-term transplant success.