Cardiovascular dysfunction and liver transplantation

Abstract

Cardiovascular complications have emerged as the leading cause of death after liver transplantation, particularly among those with advanced liver cirrhosis. Therefore, a thorough and accurate cardiovascular evaluation with clear comprehension of cirrhotic cardiomyopathy is recommended for optimal anesthetic management. However, cirrhotic patients manifest cardiac dysfunction concomitant with pronounced systemic hemodynamic changes, characterized by hyperdynamic circulation such as increased cardiac output, high heart rate, and decreased systemic vascular resistance. These unique features mask significant manifestations of cardiac dysfunction at rest, which makes it difficult to accurately evaluate cardiovascular status. In this review, we have summarized the current knowledge of heart and liver interactions, focusing on the usefulness and limitations of cardiac evaluation tools for identifying high-risk patients.

Keywords: Autonomic nervous system; Cardiovascular dysfunction; Coronary artery disease; Echocardiography; Liver transplantation; Ventriculo-arterial coupling.

Fig. 1.

Pressure-volume loops of the left ventricle (LV). (A) Measurements of parameters derived from a pressure-volume loop of the LV. (B) Example of pressure-volume loops. Compared to a healthy control (black dashed lines), patients with liver cirrhosis (LC) have decreased Ees, Ea, and ventriculo-arterial coupling (VAC) on a right-shifted pressure-volume loop (blue lines). Compared to survivors, Ees is similar but Ea is higher in patients who died (red lines). Consequently, VAC increases and stroke volume decreases compared to values for survivors (blue dashed lines). EDP: end diastolic pressure. Figure from Shin et al. [29] with permission.