Stachel Maxine W, DePasquale Eugene C
Section of Heart Failure, Heart Transplantation & Mechanical Circulatory Support, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Curr Opin Organ Transplant. 2024 Feb 1;29(1):50-55. doi: 10.1097/MOT.0000000000001119. Epub 2023 Nov 14.
Liver transplant is a widely accepted therapy for end-stage liver disease. With advances in our understanding of transplant, candidates are increasingly older with more cardiac comorbidities. Cardiovascular disease also represents a leading cause of morbidity and mortality posttransplant.
Preoperative cardiac risk stratification and treatment may improve short-term and long-term outcomes after liver transplant. Importantly, the appropriate frequency of surveillance has not been defined. Optimal timing of cardiac intervention in end-stage liver disease is likewise uncertain.
The approach to risk stratification of cardiovascular disease in end-stage liver disease is outlined, incorporating the AHA/ACC scientific statement on evaluation of cardiac disease in transplant candidates and more recent expert consensus documents. Further study is needed to clarify the ideal timing and approach for cardiovascular interventions.
肝移植是终末期肝病被广泛接受的治疗方法。随着我们对移植理解的进步，肝移植受者年龄越来越大，合并心脏疾病的情况也越来越多。心血管疾病也是移植后发病和死亡的主要原因。
术前心脏风险分层和治疗可能改善肝移植后的短期和长期预后。重要的是，尚未确定合适的监测频率。终末期肝病心脏干预的最佳时机同样不确定。
概述了终末期肝病心血管疾病风险分层的方法，纳入了美国心脏协会/美国心脏病学会关于评估移植候选者心脏疾病的科学声明以及最新的专家共识文件。需要进一步研究以阐明心血管干预的理想时机和方法。
