Perioperative cardiovascular assessment and management of liver transplant patients

PURPOSE OF REVIEW: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with end-stage liver disease (ESLD), particularly in the perioperative and posttransplant periods. Despite its critical impact, cardiovascular risk assessment and management strategies remain inconsistent across institutions. This review provides a timely synthesis of recent findings, highlighting the need for standardized cardiovascular evaluation and optimization in ESLD patients undergoing liver transplantation (LT). RECENT FINDINGS: Emerging data emphasize the interplay between cirrhosis, portal hypertension, systemic inflammation, and cardiovascular dysfunction, contributing to cirrhotic cardiomyopathy, coronary artery disease, arrhythmias, and heart failure. Advances in pretransplant screening suggest a shift toward risk-stratified approaches, integrating noninvasive imaging and selective coronary angiography. Intraoperative and postoperative cardiovascular complications remain prevalent, with immunosuppressive therapy exacerbating long-term CVD risk. SUMMARY: A multidisciplinary approach to cardiovascular management in ESLD patients is essential to improving LT outcomes. Standardized preoperative protocols, refined risk stratification, and evidence-based postoperative monitoring are critical to reducing CVD-related complications. Future research should focus on optimizing cardiovascular interventions, developing consensus guidelines, and improving long-term cardiovascular care in LT recipients.