Cardiovascular events after liver transplantation: MACE hurts

Altieri, Mario; Liu, Hongqun; Lee, Samuel S.

doi:10.31083/j.rcm2303091

Cited by 9 publications

(7 citation statements)

References 71 publications

(99 reference statements)

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“…Although an extensive review of this topic is beyond the scope of this manuscript, this subject has recently been reviewed in detail. 60 , 79 , 80 In particular, several studies have focused on whether CCM increases the morbidity and mortality of the transplantation procedure or predisposes to increasing risk of MACEs such as arrhythmias and heart failure, in the peri- and post-operative periods after liver transplantation.…”

Section: Clinical Relevance Of Ccmmentioning

confidence: 99%

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Liu,

Naser,

Lin

et al. 2024

JHEP Reports

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Section: Clinical Relevance Of Ccmmentioning

confidence: 99%

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Liu,

Naser,

Lin

et al. 2024

JHEP Reports

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“…Atrial fibrillation often occurs in the setting of liver transplant surgery and is the most common arrhythmia in the perioperative period and the postoperative period after transplantation [ 61 ]. Indeed, atrial fibrillation is the dominant cardiovascular complication associated with liver transplantation and is a key feature of so-called ‘MACE’ (major adverse cardiovascular event) syndrome following transplant [ 61 , 62 ]. However, the underlying mechanisms remain unclear.…”

Section: Galectin In Cirrhotic Cardiomyopathymentioning

confidence: 99%

Role of Galectin in Cardiovascular Conditions including Cirrhotic Cardiomyopathy

2023

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Abnormal cardiac function in the setting of cirrhosis and in the absence of a primary cardiac disease is known as cirrhotic cardiomyopathy. The pathogenesis of cirrhotic cardiomyopathy is multifactorial but broadly is comprised of two pathways. The first is due to cirrhosis and synthetic liver failure with abnormal structure and function of many substances, including proteins, lipids, hormones, and carbohydrates such as lectins. The second is due to portal hypertension which invariably accompanies cirrhosis. Portal hypertension leads to a leaky, congested gut with resultant endotoxemia and systemic inflammation. This inflammatory phenotype comprises oxidative stress, cellular apoptosis, and inflammatory cell infiltration. Galectins exert all these pro-inflammatory mechanisms across many different tissues and organs, including the heart. Effective therapies for improving cardiac function in patients with cirrhosis are not available. Conventional strategies for other noncirrhotic heart diseases, including vasodilators, are not feasible because of the significant baseline vasodilation in cirrhotic patients. Therefore, exploring new treatment modalities for cirrhotic cardiomyopathy is of great importance. Galectin-3 inhibitors such as modified citrus pectin, N-acetyllactosamine, TD139 and GB0139 exert anti-apoptotic, anti-oxidative and anti-inflammatory effects and thus have potential therapeutic interest. This review briefly summarizes the physiological and pathophysiological role of galectin and specifically examines its role in cardiac disease processes. We present a more detailed discussion of galectin in cardiovascular complications of cirrhosis, particularly cirrhotic cardiomyopathy. Finally, therapeutic studies of galectin-3 inhibitors in cirrhotic cardiomyopathy are reviewed.

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“…AF is the most common arrhythmia in the pre‐ and post‐liver transplant period 60,61 . The reported prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, and AF has been associated with a variety of adverse outcomes 5–7,62–64 .…”

Section: Atrial Fibrillation In Cirrhosismentioning

confidence: 99%

“…AF is the most common arrhythmia in the pre-and post-liver transplant period. 60,61 The reported prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, and AF has been associated with a variety of adverse outcomes. [5][6][7][62][63][64] In a retrospective analysis of 1727 patients who were evaluated for a liver transplant, the prevalence of AF was correlated with the MELD score.…”

Section: Atrial Fibrillation Before Liver Transplantationmentioning

confidence: 99%

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

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Summary Background Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. Aims To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. Methods An extensive literature search was performed using the terms ‘atrial fibrillation’ and ‘cirrhosis’. Guideline documents and consensus statements were explored. Results The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new‐onset AF in the post‐operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre‐transplant and post‐transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Conclusions Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

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Cardiovascular events after liver transplantation: MACE hurts

Cited by 9 publications

References 71 publications

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Role of Galectin in Cardiovascular Conditions including Cirrhotic Cardiomyopathy

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

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