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

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  • TABLE 1

    Inclusion and exclusion criteria for combined cardiac surgery and liver transplantation at Cleveland Clinic

    Inclusion criteria
    Severe or complex coronary artery or valve disease not amenable to percutaneous intervention
    Contraindication to dual antiplatelet therapy such as need for repeated paracentesis or a noncardiac intervention, or chronic thrombocytopenia
    Child-Pugh score > 8, needing cardiac surgery for cardiovascular optimization but otherwise a candidate for liver transplantation
    Patients with a very high Model for End-stage Liver Disease score who cannot wait to complete at least 3 months of dual antiplatelet therapy after a percutaneous intervention before proceeding with liver transplantation
    Left ventricular ejection fraction > 55%
    Exclusion criteria
    Left ventricular dysfunction
    Advanced chronic kidney disease
    Unsuitable coronary anatomy
    Active infection
    Extrahepatic malignancy
    Other contraindications to liver transplantation itself, such as evidence of substance abuse, history of nonadherence, and poor social resources
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