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

Disclosures

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

In This Article

Congenital Heart Disease

With the success of surgical therapies for neonatal congenital heart disease, a large number of patients with very complex intracardiac pathology are able to live to adulthood. Unfortunately, many of these patients also have HF. The mainstay for treatment for this complex cohort of patients is heart transplant; however, the increased right-sided pressures that are commonly associated with many of these congenital pathologies can compromise hepatic function and result in cirrhosis. An extensive discussion of the unique challenges in the assessment of liver and cardiac function in this population is beyond the scope of this review; however, combined heart and liver transplantation (CHLT) can be performed successfully in select candidates.[122] CHLT should be pursued at a center with expertise managing these complex cases.

Intracardiac shunts (eg patent foramen ovale [PFO]) occurs in ≈25% of the general adult population.[123] Limited evidence suggests that a PFO does not have a negative impact on early outcomes in patients undergoing LT.[124–126] Thus, although the presence of a PFO carries the theoretical risk of paradoxical embolic stroke, it appears to be a rare complication (5%-13%) and should not be considered a contraindication to LT with the possible exception of those with severe platypnea/orthodeoxia, or a history of venous thromboembolic disease and stroke.[124–128]

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