Jothimani Dinesh, Kumar Marannan Navin, Jain Karan, Krishna Aswin, Rela Mohamed
Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chennai, India.
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102554. doi: 10.1016/j.jceh.2025.102554. Epub 2025 Mar 27.
Liver transplantation (LT) is the only cure for patients with end-stage liver disease. With an increase in the prevalence of obesity and associated metabolic risk factors cardiovascular disease, in particular coronary artery disease is increasingly recognised in patients with liver cirrhosis. Identification and management of these cardiovascular risk factors may influence post-transplant clinical outcomes. A detailed assessment of patients' cardiovascular status is therefore crucial in the decision-making of patients for LT. Identification of patients with CAD requires risk stratification around perioperative and long term post-operative period. Advanced age, male sex, smoking diabetes mellitus, hypertension, obesity and metabolic-associated steatohepatitis (MASH) cirrhosis significantly increase the risk of coronary artery disease (CAD). Patients with these high-risk factors should undergo cardiac investigations with higher sensitivity to identify CAD. Patients with low-risk factors for CAD may undergo cardiac investigations with high specificity. Patients with cirrhosis may also suffer from conditions directly related to liver disease such as cirrhotic cardiomyopathy and porto-pulmonary hypertension, and conditions unrelated to liver disease such as arrhythmias. Rarely, valvular heart disease may be identified during transplant evaluation. Clinicians managing patients for liver transplantation should carefully evaluate cardiovascular risk and treat it appropriately prior to the surgery, to minimise post-transplant complication. A multidisciplinary approach involving transplant physicians, anaesthetists, cardiologists and transplant surgeons is strongly recommended.
肝移植（LT）是终末期肝病患者的唯一治愈方法。随着肥胖症患病率以及相关代谢危险因素的增加，心血管疾病，尤其是冠状动脉疾病，在肝硬化患者中越来越受到认可。识别和管理这些心血管危险因素可能会影响移植后的临床结局。因此，在决定患者是否进行肝移植时，对患者心血管状况进行详细评估至关重要。识别冠心病患者需要在围手术期和术后长期进行风险分层。高龄、男性、吸烟、糖尿病、高血压、肥胖和代谢相关脂肪性肝炎（MASH）肝硬化会显著增加冠状动脉疾病（CAD）的风险。有这些高危因素的患者应接受敏感性更高的心脏检查以识别CAD。CAD低风险因素的患者可接受特异性高的心脏检查。肝硬化患者也可能患有与肝病直接相关的疾病，如肝硬化性心肌病和门肺高压，以及与肝病无关的疾病，如心律失常。在移植评估期间很少会发现瓣膜性心脏病。负责肝移植患者管理的临床医生应在手术前仔细评估心血管风险并进行适当治疗，以尽量减少移植后并发症。强烈建议采用包括移植内科医生、麻醉师、心脏病专家和移植外科医生在内的多学科方法。
