Evaluation of recipients with significant comorbidity - patients with cardiovascular disease

Tsochatzis, Emmanuel A.; Watt, Kymberly D.; VanWagner, Lisa B.; Verna, Elizabeth C.; Berzigotti, Annalisa

doi:10.1016/j.jhep.2023.03.023

Cited by 22Organ Transplantation Techniques and OutcomesLiver Disease and TransplantationTransplantation: Methods and Outcomes

Evaluation of recipients with significant comorbidity - patients with cardiovascular disease

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Tsochatzis, Emmanuel A., Watt, Kymberly D., VanWagner, Lisa B., Verna, Elizabeth C., Berzigotti, Annalisa·2023·Journal of Hepatology

DOI 10.1016/j.jhep.2023.03.023PMC PMC11856630

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Abstract

Liver transplant(ation) (LT) is the most effective treatment for patients with decompensated liver disease. The increasing prevalence of obesity and type 2 diabetes and the growing number of patients with non-alcoholic fatty liver disease being evaluated for LT, have resulted in a greater proportion of LT candidates presenting with a higher risk of cardiovascular disease. As cardiovascular disease is a major cause of morbidity and mortality after LT, a thorough cardiovascular evaluation pre-LT is crucial. In this review, we discuss the latest evidence on the cardiovascular evaluation of LT candidates and we focus on the most prevalent conditions, namely ischaemic heart disease, atrial fibrillation and other arrhythmias, valvular heart disease, and cardiomyopathies. LT candidates undergo an electrocardiogram, a resting transthoracic echocardiography and an assessment of their cardiopulmonary functional ability as part of their standardised pre-LT work-up. Further diagnostic work-up is undertaken based on the results of the baseline evaluation and may include a coronary computed tomography angiography in patients with cardiovascular risk factors. The evaluation of potential LT candidates for cardiovascular disease requires a multidisciplinary approach, with input from anaesthetists, cardiologists, hepatologists and transplant surgeons.

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Candidates with MASLD can be safely transplanted, if properly managed.
“Despite the overall higher rate of risk factors in adults with MASLD, long-term graft and recipient survival after liver transplantation do not differ in many retrospective and registry analyses, 482,486,487 supporting that candidates with MASLD can be safely transplanted, if properly”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [488]
The Cardiovascular risk assessment section discusses evaluating NASH-related cirrhosis candidates before liver transplantation, and the Conclusions call for robust assessment and testing as NAFLD becomes more prevalent. This supports the need for careful management, but the paper does not report comparable long-term graft or recipient survival for MASLD recipients or establish that they can be safely transplanted as a group. (LLM, conf=0.76)
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Research works printed but not linked: 4

[60]Reddy ST, Thai NL, Oliva J, Tom KB, Dishart MK, Doyle M, Cardiohepatic risk assessment by CMR imaging in liver transplant candidates. Clin Transplant 2018; 32: e13229. 29498104
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EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works

Authors: Tsochatzis, E. A., Watt, K. D., VanWagner, L. B., Verna, E. C., & Berzigotti, A.
Affiliations: The Royal Free Hospital (GB)
Mayo Clinic (US)
The University of Texas Southwestern Medical Center (US)
Columbia University Irving Medical Center (US)
University of Bern (CH)
Corresponding author: Tsochatzis, Emmanuel A.
ORCID: Tsochatzis, Emmanuel A.
Watt, Kymberly D.
VanWagner, Lisa B.
Verna, Elizabeth C.
Berzigotti, Annalisa
Venue: Journal of Hepatology
Publisher: Elsevier BV
Published: 2023-06
Volume: 78
Issue: 6
Pages: 1089-1104
ISSN: 0168-8278 (ISSN-L)
DOI: 10.1016/j.jhep.2023.03.023
PMC: PMC11856630
OpenAlex: W4376870737
Cited by: 22
References: 138
Citations by year: 2026: 4 · 2025: 7 · 2024: 9 · 2023: 2
FWCI: 1.42
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Hepatology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
UCL Discovery (University College London) (submittedVersion)
BORIS (University Library Bern) (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (R56HL155093)
Topics: Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
Keywords: liver transplantation, cardiovascular disease, transplant evaluation, ischemic heart disease, atrial fibrillation, cardiac arrhythmias, valvular heart disease, cardiomyopathy, non-alcoholic fatty liver disease, obesity, type 2 diabetes, coronary CT angiography
MeSH terms: Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Risk Factors, Comorbidity, Non-alcoholic Fatty Liver Disease

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