Pre operative cardio pulmonary assessment of the liver transplant candidate

Martínez-Pallí, Graciela; Cárdenas, Andrés

doi:10.1016/s1665-2681(19)31508-x

Cited by 15 publications

(7 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is still no consensus on which assessment algorithm confers the best outcomes (17). Future research should be devoted to optimizing protocols to identify and manage respiratory complications after liver transplantation, especially among patients with increased baseline risk.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of mechanical ventilation after liver transplantation: a national database study

Yuan

Tuttle‐Newhall

Chawa

et al. 2014

The American Journal of Surgery

View full text Add to dashboard Cite

Background The impact of mechanical ventilator support (MCVS) on mortality and graft loss after liver transplantation (LT) is not well-described. Methods Multivariate analysis of a novel database linking national transplant registry and Medicare claims data was used to assess the impact of early MCVS on mortality and graft survival following LTs performed between 2002–2008. Results Among 10,517 LT recipients, 6.9% (n=726) required post-operative MCVS, 25.6% of who required < 96 hrs, 24.2% ≥ 96 hrs, and 50.1% an unspecified duration. Significant predictors of prolonged MCVS included older age, female gender, pre-transplant dialysis requirement and ascites. After multivariate adjustment, MCVS ≥96hrs was associated with nearly 3-times the adjusted hazard ratio (aHR) of mortality (2.95, P=<0.001), while MCVS <96 hrs was not significantly associated with mortality (aHR 0.88, P=0.55). Conclusions Recognition of LT patients at-risk for prolonged MCVS may help to reduce the incidence and consequences of this complication.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognostic impact of mechanical ventilation after liver transplantation: a national database study

Yuan

Tuttle‐Newhall

Chawa

et al. 2014

The American Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…However, these risk algorithms and tests have poor discriminative ability to predict early cardiac mortality after LT. 9,10 Current guidelines for preoperative cardiac evaluations before noncardiac surgery are based on studies of patient cohorts not undergoing LT, so the optimal preoperative cardiac evaluation for LT patients remains unknown. 9,11,12 Although many studies have reported an increased incidence of longterm CVD complications after transplantation, few have focused on predictors of early CVD outcomes. 13,14 In addition, despite the high prevalence of cirrhotic cardiomyopathy, studies of early CVD outcomes after LT have predominantly focused on complications of ischemic heart disease.…”

mentioning

confidence: 99%

High early cardiovascular mortality after liver transplantation

et al. 2014

View full text Add to dashboard Cite

Cardiovascular disease (CVD) contributes to excess long-term mortality after liver transplantation (LT), however little is known about early post-operative CVD mortality in the current era. In addition, there is no model to predict early post-operative CVD mortality across centers. We analyzed adult recipients of primary LT in the Organ Procurement and Transplantation Network (OPTN) database between February 2002 and December 2012 to assess prevalence and predictors of early (30-day) CVD mortality, defined as death from arrhythmia, heart failure, myocardial infarction, cardiac arrest, thromboembolism, and/or stroke. We performed logistic regression with stepwise selection to develop a predictive model of early CVD mortality. Sex and center volume were forced into the final model, which was validated using bootstrapping techniques. Among 54,697 LT recipients, there were 1576 (2.9%) deaths within 30 days. CVD death was the leading cause of 30-day mortality (42.1%), followed by infection (27.9%) and graft failure (12.2%). In multivariate analysis, 9 (6 recipient, 2 donor, 1 operative) significant covariates were identified: age, pre-operative hospitalization, ICU and ventilator status, calculated MELD score, portal vein thrombosis, national organ sharing, donor BMI and cold ischemia time. The model showed moderate discrimination (c-statistic 0.66, 95% CI: 0.63–0.68). We provide the first multicenter prognostic model for the prediction of early post-LT CVD death, the most common cause of early post-LT mortality in the current transplant era. However, evaluation of additional CVD-related variables not collected by the OPTN are needed in order to improve model accuracy and potential clinical utility.

show abstract

“…By some estimates, 25-70% of the patients suffer cardiac events during and after LT [37]. In addition to CAD, 40-50% of patients with cirrhosis develop cardiac changes, called cirrhotic cardiomyopathy, irrespective of age.…”

Section: Cardiovascular System Changes With Cirrhosismentioning

confidence: 99%

Preoperative evaluation of geriatric patients undergoing liver transplantation

Akhtar

2021

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewAs the population of the world is aging the number of geriatric patients undergoing liver transplantation (LT) is also increasing. They pose a unique challenge for the caregivers, as they have age-related physiological changes, multiple comorbidities and cirrhosis-related pathologies. Recent findingsTwenty-two percent of patients who undergo LT are older than 65 years. Many patients suffer from nonalcoholic steatohepatitis (NASH), hepatocellular carcinoma and hepatitis-C virus. Incidence of NASH tends to increase with age, obesity, diabetes and metabolic syndrome. Elderly patients require comprehensive cognitive, cardiac and pulmonary evaluation prior to LT. Cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension and frailty are of specific concern.

show abstract

Pre operative cardio pulmonary assessment of the liver transplant candidate

Cited by 15 publications

References 106 publications

Prognostic impact of mechanical ventilation after liver transplantation: a national database study

Prognostic impact of mechanical ventilation after liver transplantation: a national database study

High early cardiovascular mortality after liver transplantation

Preoperative evaluation of geriatric patients undergoing liver transplantation

Contact Info

Product

Resources

About