Nagraj Sanjana, Peppas Spyros, Rubianes Guerrero Maria Gabriela, Kokkinidis Damianos G, Contreras-Yametti Felipe I, Murthy Sandhya, Jorde Ulrich P
Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York City, NY 10461, United States.
Department of Gastroenterology, Athens Naval Hospital, Athens 115 21, Greece.
World J Transplant. 2022 Jul 18;12(7):142-156. doi: 10.5500/wjt.v12.i7.142.
Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.
心血管疾病（CVD）是接受肝移植（LT）评估的终末期肝病（ESLD）患者的主要考量因素，对移植围手术期和术后的预后有影响。随着ESLD的主要病因不断演变，处理这些患者的心血管疾病变得越来越重要。同样，随着每年肝移植数量的增加，等待名单上患有多种合并症的老年人比例增加，肝移植候选者的人口统计学特征也在演变，其心血管疾病风险状况也相应增加。心脏风险评估的主要目标是预先降低移植围手术期和术后因血流动力学应激可能出现的心血管发病和死亡风险。ESLD患者在移植前期具有复杂的血流动力学，只有部分受者会发生不良心血管事件，这继续对现有指南及其统一适用性构成挑战。本综述以循序渐进的方式重点关注肝移植候选者的心脏评估，特别强调术前患者的优化。我们希望这将强化肝移植前心血管优化的重要性，防止那些处于优化阶段之外的晚期心血管疾病患者进行徒劳的肝移植，从而谨慎地使用有限的资源。
