Cardiovascular disease in liver transplant candidates

SummaryHeart disease was thought to be rare in patients with chronic liver failure. As surgical technique and immunosuppression have improved, heart disease has emerged as a leading cause of complications and death following transplantation. The two most common conditions are ischemic heart disease and cardiomyopathy. There is no agreement how transplant candidates should be evaluated for heart disease. It is difficult to apply standard protocols used in other surgical patients to transplant recipients since the operation and postoperative care are unique. Most investigators agree that there is an increased prevalence of coronary disease in transplant candidates. The reasons for this observation are unknown. Liver disease is also an independent risk factor for the development of cardiomyopathy. Infiltrative cardiomyopathy is associated with Hepatitis C infection and metabolic storage diseases such as Hemochromatosis. Cirrhotic cardiomyopathy appears to be a condition unique to patients with liver disease. Patients develop defects in systolic, diastolic and electrophysiological function. This review summarizes current information on the topics of coronary artery disease and cardiomyopathy in patients with advanced liver disease.