Preoperative Cardiological Assessment in Liver Transplant Candidates

Objectives: This study aims to collect information from the literature on cardiologic assessment in patients who are candidates for liver transplantation (LT) and to present the main findings and evidence related to this topic. Methods: This review article collects the evidence available in the literature regarding the importance of cardiological evaluation in patients who are candidates for LT to improve patient selection and care. To prepare this review article, articles published in scientific databases on the PubMed/MEDLINE, LILACS, and SciELO platforms were consulted and selected. Results: The coronary artery disease in LT (CAD-LT) score has a high sensitivity for predicting the risk of CAD in patients who are candidates for LT and should be used whenever possible. Currently, coronary angiography remains the gold standard for assessing CAD in these patients. If this test is not indicated, multidetector computed tomography (CT) angiography can be used as a substitute, as it can classify the degree of atherosclerotic lesion, although it is less sensitive. Echocardiography under pharmacological stress with dobutamine can help detect myocardial ischemia and, in particular, investigate heart failure (HF) and other cardiomyopathies, as its sensitivity for CAD is low compared with other tests. Conclusion: LT is the second most performed massive viscus transplantation procedure in the world, second only to kidney transplantation. As it is a complex procedure, some complications are possible, with cardiovascular complications being the leading cause of death not related to the graft and the third overall cause of death among patients undergoing LT. Considering the high prevalence of cardiovascular diseases and their presentation as one of the main causes of death worldwide, it is essential that candidates for LT undergo rigorous screening prior to undergoing LT.