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Pre-transplant Cardiovascular Risk Assessment and Modification

  • Liver (E Tapper, Section Editor)
  • Published:
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Abstract

Purpose of review

Cardiovascular complications are a leading cause of morbidity and mortality after liver transplantation (LT). However, the assessment of cardiovascular risk in LT candidates is highly heterogeneous despite data supporting a standardized risk assessment approach. In this review, we highlight the current evidence for cardiovascular risk assessment in LT candidates, particularly in terms of coronary artery disease, as well as further research needed.

Recent findings

The evaluation of coronary anatomy by non-invasive coronary angiography is feasible and effective for the detection of obstructive coronary artery disease in LT candidates. Increasing awareness of the limitations of universal stress testing for detection of obstructive coronary artery disease restricts use to individualized cases. Invasive coronary angiography is safe and effective in terms of prediction of post-LT cardiac events. There is little evidence on the assessment of other cardiovascular conditions.

Summary

New data exist that need to be incorporated into clinical practice regarding the evaluation of coronary artery disease in LT candidates using a predominantly anatomic approach. There is little information on the management of other cardiovascular conditions in this high cardiac risk population.

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Abbreviations

ACLF:

Acute-on-chronic liver failure

ASCVD:

Atherosclerotic cardiovascular disease

BMS:

Bare metal stents

BNP:

B-type natriuretic peptide

CACS:

Coronary artery calcium score

CAD:

Coronary artery disease

CCM:

Cirrhotic cardiomyopathy

CCTA:

Coronary computed tomography angiography

CV:

Cardiovascular

CVE:

Cardiovascular event

CVR:

Cardiovascular risk

CVRF:

Cardiovascular risk factor

DAPT:

Dual anti-platelet therapy

DES:

Drug-eluting stents

DSE:

Dobutamine stress echocardiography

ECG:

Electrocardiography

FFR:

Fractional flow reserve

GLS:

Global longitudinal strain

HCV:

Hepatitis C virus

HF:

Heart failure

ICA:

Invasive coronary angiography

LDL:

Low-density lipoprotein

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

NAFLD:

Non-alcoholic fatty liver disease

TTE:

Transthoracic echocardiography

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Acknowledgements

GC was granted by Instituto Carlos III (ISCIII)-Subdirección General de Evaluación y Fomento de la Investigación, cofunded by the European Regional Development Fund (PI18/00727), and by the Asociación Española para el Estudio del Hígado (AEEH) Juan Rodes Grant 2021. LVW is supported by the National Heart, Lung, and Blood Institute grant K23 HL136891.

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Authors and Affiliations

  1. Liver Transplant and Hepatology Units, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain

    Gonzalo Crespo MD

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Lisa B. VanWagner MD, MSc, FAST, FAHA

  3. Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Lisa B. VanWagner MD, MSc, FAST, FAHA

  4. Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 1400, Chicago, IL, 60611, USA

    Lisa B. VanWagner MD, MSc, FAST, FAHA

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  1. Gonzalo Crespo MD
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Correspondence to Lisa B. VanWagner MD, MSc, FAST, FAHA.

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Gonzalo Crespo declares that he has no conflict of interest. Lisa B. VanWagner declares that she has no conflict of interest.

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Crespo, G., VanWagner, L.B. Pre-transplant Cardiovascular Risk Assessment and Modification. Curr Treat Options Gastro 20, 177–193 (2022). https://doi.org/10.1007/s11938-022-00379-w

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