Review

Cardiac considerations in liver transplantation

Vikram Sharma, MD, MD(Res), Cerise Kleb, MD, Chirag Sheth, MD, Beni Rai Verma, MD, Vardhmaan Jain, MD, Ruchi Sharma, MD, MS, Parth Parikh, MD, Jacek Cywinski, MD, K. V. Narayanan Menon, MD, FAASLD, Jamak Modaresi Esfeh, MD, Bijan Eghtesad, MD, Cristiano Quintini, MD, Teresa Diago Uso, MD, Michael Z. Y. Tong, MD, Ravi Nair, MD, Ajay Bhargava, MD and Maan Fares, MD
Cleveland Clinic Journal of Medicine January 2022, 89 (1) 46-55; DOI: https://doi.org/10.3949/ccjm.89a.21006

ABSTRACT

Cardiovascular events have a major impact on overall outcomes after liver transplantation. Today’s transplant patients are older than those in the past and therefore are more likely to have coexisting cardiac comorbidities. In addition, pathophysiologic effects of advanced liver disease on the circulatory system pose challenges in perioperative management. This review discusses important preoperative, intraoperative, and postoperative cardiac considerations in patients undergoing liver transplant.

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  1. Vikram Sharma, MD, MD(Res)
  1. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH; Department of Cardiovascular Medicine, University of Iowa, Iowa City
  1. Cerise Kleb, MD
  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
  1. Chirag Sheth, MD
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
  1. Beni Rai Verma, MD
  1. Department of Hospital Medicine, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Vardhmaan Jain, MD
  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
  1. Ruchi Sharma, MD, MS
  1. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH
  1. Parth Parikh, MD
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Clinical Instructor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 3991-jacek-cywinskiJacek Cywinski, MD
  1. Department of General Anaesthesia, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 9133-k-v-narayanan-menonK. V. Narayanan Menon, MD, FAASLD
  1. Medical Director of Liver Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 20949-jamak-modaresi-esfehJamak Modaresi Esfeh, MD
  1. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
  1. 6031-bijan-eghtesadBijan Eghtesad, MD
  1. Digestive Disease and Surgery Institute, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 8041-cristiano-quintiniCristiano Quintini, MD
  1. Digestive Disease and Surgery Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 18056-teresa-diago-usoTeresa Diago Uso, MD
  1. Digestive Disease and Surgery Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 17126-michael-zhen-yu-tongMichael Z. Y. Tong, MD
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 8909-ravi-nairRavi Nair, MD
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Professor Emeritus, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 6679-ajay-bhargavaAjay Bhargava, MD
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. 1974-maan-faresMaan Fares, MD⇑
  1. Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Address:
    Maan Fares, MD, Heart, Vascular, and Thoracic Institute, J2-4, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; faresm{at}ccf.org

ABSTRACT

Cardiovascular events have a major impact on overall outcomes after liver transplantation. Today’s transplant patients are older than those in the past and therefore are more likely to have coexisting cardiac comorbidities. In addition, pathophysiologic effects of advanced liver disease on the circulatory system pose challenges in perioperative management. This review discusses important preoperative, intraoperative, and postoperative cardiac considerations in patients undergoing liver transplant.

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