Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ BACKGROUND ++ Cardiopulmonary complications after orthotopic liver transplantation are common, at rates reported between 25% and 70%, which is higher than for other solid organ transplants.1–3 Represents the third leading cause of death behind infection and rejection (22% of all late mortalities).4 Although the principal risk factors for development of these events are the intraoperative transfusion and the patient age, other causes of this higher rate among liver transplant patients remains unknown. Most occur within the first 6 months (early) after transplant. Attempts to avoid these events are mandatory, mainly because they represent a major source of morbidity and mortality after liver transplantation. +++ THE TRANSPLANT EVALUATION TEAM ++ Cardiovascular events posttransplantation should be evaluated by a skilled multidisciplinary team, including the cardiology and pulmonology team. Risks, benefits, and the process from preoperative evaluation to postoperative evaluation and long-term follow-up should be reviewed with the patient (when appropriate) and the family/caregivers in each step in order to determine whether to proceed or not based on an informed decision. +++ PREDICTIVE RISK FACTORS ASSOCIATED WITH CARDIOVASCULAR COMPLICATIONS ++ Pretransplant factors:5,6 Recipient’s age7 Hypercholesterolemia Systolic hypertension Severe ascites Metabolic disturbances before liver transplant Hyponatremia Hyperhomocysteinemia Severity of liver dysfunction (high integrated Model for End-Stage Liver Disease [MELD] score, high MELD-Na score, high MELD score) Diastolic dysfunction (low E/A ratio and prolonged EDT)8 Elevated serum troponin levels Elevated blood urea nitrogen (BUN) Elevated brain natriuretic peptide (BNP) Abnormal spirometry findings Chronic alcohol consumption Smoking history Acute renal failure Mechanical ventilation due to severe respiratory failure High values of international normalized ratio (INR) Deceased donor source of organ transplantation Cirrhotic encephalopathy Cardiac disease history: Coronary artery disease (CAD) Coronary artery bypass graft (CABG) Valvulopathy Percutaneous transluminal coronary angioplasty with stent placement (PTCA-STENT) Major intraoperative risk factors: Surgical procedure9,10 Intraoperative fluid transfusion volume9,11,12 Intraoperative blood transfusion volume11,13 Perioperative fluid balance11 Intraoperative fluid retention14 Intraoperative bleeding volumes14 Posttransplant factors: Surgical ischemic times Graft quality Amount of intraoperative transfused blood and plasma Decreased high-density lipoprotein cholesterol (HDL-C) Renal impairment Concomitant cardiopulmonary toxic drugs Excessive perioperative fluid administration9 Delayed weaning from mechanical ventilation9,10,15 Acute rejection during the hospital stay9 Postoperative acute renal failure16 Postoperative hypoproteinemia Onset of renal insufficiency Poor postoperative myocardial function Right hemidiaphragm paralysis17 Greater exposure to nosocomial agents18 Significant decline in the recipient’s immune function18 Surgical complications18 Reinterventions or need for retransplantation18 +++ MANAGEMENT ++ Prevention:5 Preoperative strategies: Pulmonary rehabilitation prior to orthoptic liver transplant (OLT) Intraoperative strategies: Reduction in the degree of surgical insult Reduction in the level of aggressiveness Reduction in the duration of the procedure Reduction in the amount of blood lost Postoperative strategies: Early extubation Adequate postoperative pain relief Optimal hemodynamic and fluid management Improvement of general health and nutrition Lung expansion maneuvers Deep breathing ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.