Multidisciplinary Approach to Cardiac and Pulmonary Vascular Disease Risk Assessment in Liver Transplantation

An Evaluation of the Evidence and Consensus Recommendations

Lisa B. VanWagner; Matthew E. Harinstein; James R. Runo; Christopher Darling; Marina Serper; Shelley Hall; Jon A. Kobashigawa; Laura L. Hammel


American Journal of Transplantation. 2018;18(1):30-42. 

In This Article


Patients with ESLD are at increased risk for cardiac events compared with the general population. Cardiovascular disease remains a leading cause of death in LT recipients, with the highest rates occurring immediately after transplantation.[2,3] This increased cardiovascular risk is related to traditional and nontraditional cardiac risk factors, including altered cardiovascular physiology in ESLD.

The goals of cardiovascular assessment in LT candidates are to (1) determine intraoperative and immediate postoperative survival and (2) estimate long-term cardiovascular survival to avoid futility of LT and maximize the benefit of a scarce donor organ. Table 2 summarizes consensus recommendations based upon the available body of evidence regarding the diagnosis and management of cardiovascular disease in patients with ESLD. Candidates at high risk for underlying cardiovascular disease or those with abnormalities found on routine screening as outlined in Table 2 should be referred to a cardiologist or pulmonary hypertension specialist, as appropriate. Despite available evidence, a significant knowledge gap in the study of cardiovascular outcomes in patients undergoing LT persists. The unique physiology of ESLD can profoundly influence accurate diagnosis, management, and outcomes of underlying cardiac pathology, and requires a careful evidence-based and multidisciplinary approach to the perioperative cardiovascular management of LT candidates.