Coronary events in patients undergoing orthotopic liver transplantation: perioperative evaluation and management

• Published in: Clinical transplantation Vol. 27; no. 3; pp. E207 - E215
• Main Authors: Ali, Asghar, Bhardwaj, Hem L., Heuman, Douglas M., Jovin, Ion S.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.05.2013
• Subjects: Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; coronary events; Disease Management; Humans; Liver Diseases - complications; Liver Diseases - therapy; liver transplant; Liver Transplantation; nuclear cardiology; Perioperative Care; pre-operative risk assessment; stress echocardiography
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12113

Patients with advanced liver disease have a high prevalence of cardiac risk factors. The stress of liver transplant surgery predisposes these patients to major cardiac events, such as myocardial infarction or ventricular arrhythmias in addition to heart failure exacerbation. Liver transplant patients who experience coronary events in the perioperative period have a decreased five‐yr survival rate. Cardiovascular risk stratification prior to liver transplant can be accomplished by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computed tomography, and coronary angiography. Pre‐liver transplant management of cardiovascular pathology includes cardiovascular intervention like percutaneous coronary intervention, coronary bypass graft surgery, or medical management. Thorough screening and optimal management of underlying cardiovascular pathology and cardiovascular risk factors should decrease the incidence of new cardiac events in liver transplant recipients.