Ahmed Zaky
University of Alabama at Birmingham, USA
Title: Appraising cardiac dysfunction in liver transplantation: An ongoing challenge
Biography
Biography: Ahmed Zaky
Abstract
End stage liver disease (ESLD) is a multi-system disease that complexly and mutually interacts with other body organs. The heart is one of the organs most adversely affected by liver disease both directly and indirectly. Cardiac dysfunction in the setting of cirrhosis may contribute to mortality as high as 50% post liver transplantation. The spectrum of heart diseases associated with liver cirrhosis includes 3 major groups:
1. Underlying heart disease aggravated by cirrhosis
2. Heart disease that is caused by a pathologic process that concomitantly affects the heart and the liver
3. Cirrhosis-associated cardiac disease, which may be vascular, myocardial or pericardial.
Liver transplantation while considered the definitive treatment of patients with ESLD, can independently contribute to further deterioration of pre-existing cirrhosis-associated cardiac dysfunction. These adverse effects occur as a result of acute changes in loading conditions, and the liberation of inflammatory cytokines and other mediators during graft reperfusion. Furthermore, following liver transplantation there is an increased risk of adverse cardiac events associated with chronic immunosuppressive therapy. Thus, such patients require a thorough cardiac evaluation prior to being deemed acceptable liver transplant candidates.
A thorough cardiac evaluation of liver transplant candidates is a challenging task, however. Altered cardiac response to stress, the heterogeneity of cardiac disease in liver transplant candidates, and the paucity of well-designed studies investigating preoperative cardiac testing; all explain the current lack of agreement on a single best screening strategy to optimize perioperative and postoperative outcomes.
This talk will discuss the following: profiles of cardiac dysfunction in ESLD, short and long term cardiac dysfunction associated with liver transplantation, and the preoperative evaluation of liver transplant candidates in light of the current evidence, appraising its limitations. Also, this talk will propose avenues for future investigation of cardiac function in liver transplant candidates.
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