Stroke Volume Response to Liver Graft Reperfusion Stress in Cirrhotic Patients

Escobar, Bibiana; Taurà, Pilar; Martínez-Pallí, Graciela; Fondevila, Constantino; Balust, Jaume; Beltrán, Joan; Fernández, Javier; García‐Pagán, Juan Carlos; García‐Valdecasas, Juan Carlos

doi:10.1007/s00268-013-2289-x

Cited by 9 publications

(5 citation statements)

References 40 publications

(45 reference statements)

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“…The model for end-stage liver disease (MELD) score was weighted for hepatocarcinoma according to Sharma and colleagues 13 (range 6-40). General anesthesia was administered as previously described, 14 blood products were transfused according to our protocol that we started from 2007. 15 Patients under coumarin drugs were preoperatively reversed with prothrombin complex concentrate (Octaplex; Octapharma, Canada) until the international normalized ratio < 2.…”

Section: Methodsmentioning

confidence: 99%

Venous Thrombotic Events After Liver Transplantation

Blasi

Hernández

Fernández

et al. 2016

Clin Appl Thromb Hemost

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Thromboprophylaxis is not well defined after liver transplantation (LT). The aim of this study was to evaluate the incidence of splanchnic vein thrombosis (SVT) and nonsplanchnic vein thrombosis (NSVT) after LT. Liver transplantations performed between 2009 and 2013 in our institution were reviewed. Demographic, intraoperative, and postoperative data were recorded. Low-molecular-weight heparin was only administered postoperatively if intraoperative thrombectomy was performed or in patients preoperatively anticoagulated. Of a total of 328 patients, 72% were male with a median age of 56 years, score of model for end-stage liver disease 18 (11-23), and 88% had liver cirrhosis. The incidence of postoperative venous thrombotic events was 4.6%: 8 (2.4%) patients had SVT and 7 (2.1%) patients had NSVT. After logistic regression analysis, intraoperative thrombectomy and Child A classification emerged as risk factors for SVT (odds ratio [OR]: 77, 95% confidence interval [95% CI]: 14-421) and NSVT (OR: 20, 95% CI: 3-170), respectively. The incidence of SVT in patients who undergo intraoperative thrombectomy was 33%, whereas the incidence of NSVT in patients grouped as Child A was 7.5%. Our results suggest that thromboprophylaxis should be considered after LT in patients with cirrhosis grouped as Child A and in patients who undergo intraoperative thrombectomy.

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Section: Methodsmentioning

confidence: 99%

Venous Thrombotic Events After Liver Transplantation

Blasi

Hernández

Fernández

et al. 2016

Clin Appl Thromb Hemost

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Section: Hemodynamic Changes During Ltmentioning

confidence: 99%

“…A subset of patients undergoing LT develop an abnormal cardiac response characterized by a decrease in stroke work despite an increase in preload[ 18 ]. This is associated with a longer post-operative intubation time and poor surgical outcomes[ 18 , 19 ]. Although these cardiovascular complications can be anticipated, the cardiac response during LT tends to vary significantly between individuals depending on competing comorbidities and presence of preexisting cardiomyopathy[ 20 ].…”

Section: Hemodynamic Changes During Ltmentioning

confidence: 99%

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Nagraj¹,

Peppas²,

Guerrero³

et al. 2022

WJT

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Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.

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“…61 A sudden increase in preload is also seen after graft reperfusion during liver transplantation. 28,62 Patients with CCM and other cardiomyopathies cannot accommodate this volume loading, resulting in increased pulmonary capillary wedge pressure (PCWP), hepatic congestion, and hemodynamic instability. 63 Escobar et al 62 showed that preoperative low-systemic vascular resistance and increased left atrium (LA) were independent predictors of inadequate cardiac response after graft reperfusion.…”

Section: Clinical Featuresmentioning

confidence: 99%

Cirrhotic Cardiomyopathy—A Veiled Threat

Scărlătescu

Марченко

Tomescu

2020

Cardiology in Review

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Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with liver cirrhosis without preexisting cardiac disease. According to the definition established by the World Congress of Gasteroenterology in 2005, the diagnosis of CCM includes criteria reflecting systolic dysfunction, impaired diastolic relaxation, and electrophysiological disturbances. Because of minimal or even absent clinical symptoms and echocardiographic signs at rest according to the 2005 criteria, CCM diagnosis is often missed or delayed in most clinically stable cirrhotic patients. However, cardiac dysfunction progresses in time and contributes to the pathogenesis of hepatorenal syndrome and increased morbidity and mortality after liver transplantation, surgery, or other invasive procedures in cirrhotic patients. Therefore, a comprehensive cardiovascular assessment using newer techniques for echocardiographic evaluation of systolic and diastolic function, allowing the diagnosis of CCM in the early stage of subclinical cardiovascular dysfunction, should be included in the screening process of liver transplant candidates and patients with cirrhosis in general. The present review aims to summarize the most important pathophysiological aspects of CCM, the usefulness of contemporary cardiovascular imaging techniques and parameters in the diagnosis of CCM, the current therapeutic options, and the importance of early diagnosis of cardiovascular impairment in cirrhotic patients.

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Stroke Volume Response to Liver Graft Reperfusion Stress in Cirrhotic Patients

Cited by 9 publications

References 40 publications

Venous Thrombotic Events After Liver Transplantation

Venous Thrombotic Events After Liver Transplantation

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Cirrhotic Cardiomyopathy—A Veiled Threat

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