Cardiac Evaluation in Liver Transplantation

  • Florian HacklEmail author
  • Andrei Kopylov
  • Michael Kaufman
Anesthesia and Critical Care in Transplantation (D Axelrod and M Kaufman, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anesthesia and Critical Care in Transplantation


Purpose of Review

With more than 14,000 patients awaiting liver transplantation in the USA and a mortality rate of 20–25% on the wait list, a diligent pre-operative evaluation is crucial to ensure optimal risk assessment. Cardiac disease remains the leading cause of early mortality after liver transplantation. In this review, we discuss common cardiac comorbidities, frequently used testing modalities, and updated literature on cardiac evaluation in liver transplant candidates.

Recent Findings

Optimal cardiac evaluation, especially in the asymptomatic patient, remains controversial as shown by conflicting results in the literature. Non-invasive testing is associated with low sensitivity in this patient population; therefore, coronary angiography remains the standard for detecting CAD.


There is general agreement that all liver transplant candidates have to undergo cardiac evaluation; however, universally accepted guidelines are currently not available. Often the choice of the cardiac evaluation modality has to be made on a case-by-case basis by a multidisciplinary transplant team based on the perceived risk of invasive studies when compared to perioperative cardiac events.


Liver transplantation Pre-operative cardiac evaluation Cirrhotic cardiomyopathy Perioperative mortality Post-operative complications 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Florian Hackl
    • 1
    Email author
  • Andrei Kopylov
    • 1
  • Michael Kaufman
    • 1
  1. 1.Department of Anesthesiology, Lahey Hospital and Medical CenterTufts University School of MedicineBurlingtonUSA

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