Echocardiography in Liver Transplant Candidates

Garg, Anubhav; Armstrong, William F.

doi:10.1016/j.jcmg.2012.11.002

Cited by 63 publications

(62 citation statements)

References 66 publications

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“…In contrast to the Hepatorenal Syndrome and renal insufficiency [36], it is not fully clear how coronary heart disease is linked to end-stage liver disease [37] but these patients clearly have an increased risk of mortality [38] independently of liver transplantation. While some literature sources have suggested that a protective effect of cirrhosis on atherosclerosis and myocardial infarction might exist [39], [40], there is a prevalence of coronary heart disease of up to 27% in patients with end-stage liver disease [35], [41]–[43].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

et al. 2014

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Background and AimsLiver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.MethodsBetween December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.ResultsA labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0–1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5–6: 60.9 and 66.2%).ConclusionsIn this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

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Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

et al. 2014

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“…The peripheral vasodilation and elevated cardiac output of ESLD result in high transvalvular flows velocities that may overestimate the degree of stenosis [13, 14]. Cirrhotic cardiomyopathy will mask left ventricular systolic dysfunction and induce diastolic dysfunction and left ventricular hypertrophy [15, 16].…”

Section: Discussionmentioning

confidence: 99%

“…The careful use of dobutamine stress echocardiography, as well as transesophageal echocardiography and catheter-based assessments, may help to verify the severity of AS and distinguish entities such as pseudo AS and paradoxical low-flow, low-gradient AS [18–20]. The use of a gradient only based assessment of valve severity should be discouraged [14]. …”

Section: Discussionmentioning

confidence: 99%

Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease

Coverstone

Korenblat

Crippin

et al. 2014

Case Reports in Cardiology

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The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.

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“…Moreover, other surgical stresses including TIPS have also been reported to be accompanied by an increase in the pulmonary capillary wedge pressure and to precipitate overt heart failure in these patients [28]. Unfortunately, predicting patients who are more prone to the development of post-transplantation/ TIPS cardiac complications is still a big challenge [1,29]. Two-dimensional and dobutamine stress echocardiography were utilized to predict the development of adverse cardiac events following liver transplantation and both had a low predictive value [27].…”

Section: Post-interventional Cardiac Complications Can We Add Somethmentioning

confidence: 99%

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2016

BAOJMN

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AimTo assess noninvasively the left ventricular filling pressure in patients with liver cirrhosis. MethodsThirty-five patients with liver cirrhosis were enrolled in the study in addition to 16 age-and sex-matched controls. All participants were subjected to full echocardiographic assessment. Evaluation of the left ventricular diastolic function and filling pressure was made using both the conventional and tissue Doppler imaging. ResultsHeart rate was significantly higher in patients with liver cirrhosis compared with the controls (86 ± 6.5 bpm vs 72± 4, P = 0.04).The mitral E/A ratio was significantly lower in patients with liver cirrhosis (mean age, 53±6 years) and was correlated with the severity of liver impairment (P = 0.04, r = -0.335). Compared to the controls, the left ventricular filling pressure was significantly elevated in patients with liver cirrhosis (10±3 vs 9±1, P = 0.002). All patients with elevated filling pressure (75% of them were females) had more advanced form of liver impairment, and were categorized as having normal left ventricular diastolic functions using the mitral inflow indexes. ConclusionsThe resting left ventricular filling pressure is elevated in patients with liver cirrhosis. Further studies are warranted to determine whether these patients are more prone to the development of cardiac complications (mainly pulmonary edema) following liver transplantation. The use of multiple parameters, rather than the mitral indexes only, to assess the left ventricular diastolic functions in patients with liver cirrhosis is recommended.

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Echocardiography in Liver Transplant Candidates

Cited by 63 publications

References 66 publications

Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease

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