Muderrisoglu Haldun, Yilmaz Kerem Can, Karacaglar Emir, Bal Ugur, Aydinalp Alp, Moray Gokhan, Haberal Mehmet
Cardiology Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2017 Mar;15(Suppl 2):65-68. doi: 10.6002/ect.TOND16.L17.
Liver transplant is a high-risk surgery for cardiac events. The risk of 30-day major cardiac adverse events is estimated at more than 5%. In this retrospective study, we evaluated our preoperative cardiac risk assessment approach.
We evaluated 58 adult patients who underwent liver transplant between May 2011 and May 2015. Preoperative cardiac risk factors and results of diagnostic tests were noted. Patients were divided into 2 groups: patients with or without hepatocellular carcinoma. Electrocardiogram, echocardiogram, and treadmill tests were performed for preoperative cardiac evaluation in all candidates for liver transplant. Results of these tests showed our preference for myocardial perfusion scintigraphy and/or coronary angiography and heart catheterization.
Mean age of patients was 46.5 ± 14.5 years. The most common cardiovascular risk factor was family history of coronary artery disease (24.1%) in all patients. Diabetes mellitus (15.5%) was the most common risk factor in the patient group without hepatocellular carcinoma. Three patients had already known coronary artery disease (5.2%). Of 16 patients (27.6%) who underwent coronary angiography, 4 were in the hepatocellular carcinoma group. Coronary revascularization by stent implantation was necessary for 1 patient in the hepatocellular carcinoma group; 1 patient in the group without hepatocellular carcinoma underwent preoperative coronary bypass surgery.
No consensus exists for cardiovascular risk stratification and preoperative cardiovascular evaluation of liver transplant candidates. Noninvasive stress tests are not always feasible for all liver transplant candidates because of poor mobility and poor exercise capacity. With early diagnoses of cardiovascular conditions and preventive recommendations, liver transplant can be performed safely before spread of the disease, which is essential for carcinoma patients. Angiographic evaluation of liver transplant candidates for hepatocellular carcinoma is strongly recommended.
肝移植是一种心脏事件的高风险手术。30天主要心脏不良事件的风险估计超过5%。在这项回顾性研究中，我们评估了我们的术前心脏风险评估方法。
我们评估了2011年5月至2015年5月期间接受肝移植的58例成年患者。记录术前心脏危险因素和诊断测试结果。患者分为两组：有或无肝细胞癌的患者。对所有肝移植候选者进行心电图、超声心动图和跑步机测试以进行术前心脏评估。这些测试结果显示我们更倾向于心肌灌注闪烁显像和/或冠状动脉造影及心导管检查。
患者的平均年龄为46.5±14.5岁。所有患者中最常见的心血管危险因素是冠状动脉疾病家族史（24.1%）。糖尿病（15.5%）是无肝细胞癌患者组中最常见的危险因素。3例患者已有冠状动脉疾病（5.2%）。在接受冠状动脉造影的16例患者（27.6%）中，4例在肝细胞癌组。肝细胞癌组中有1例患者需要通过支架植入进行冠状动脉血运重建；无肝细胞癌组中有1例患者接受了术前冠状动脉搭桥手术。
对于肝移植候选者的心血管风险分层和术前心血管评估尚无共识。由于活动能力差和运动能力差，无创应激测试并非对所有肝移植候选者都可行。通过早期诊断心血管疾病并给出预防性建议，肝移植可以在疾病扩散之前安全进行，这对癌症患者至关重要。强烈建议对肝细胞癌肝移植候选者进行血管造影评估。
