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Liver Transplantation as a Challenge for the Anesthesiologist: Preoperative Cardiac Assessment to Orient the Perioperative Period

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Liver Transplantation and Hepatobiliary Surgery

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Liver transplantation (LT) requires specific competences and relevant skills for the appropriate management of the pretransplant evaluation, particularly as regards cardiac assessment. Elderly candidates (aged well beyond 65 years old) are now very often accepted for LT, in spite of increased comorbidities and a higher cardiovascular risk, amplified by manifestations associated with a long-standing cirrhosis (the most common end-stage liver disease in LT candidates) and portal hypertension (cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary syndrome). The incidence of coronary artery disease is increasing among candidates but unfortunately no consensus exists on the stepwise paradigms to be adopted for the diagnosis and management of coronary artery disease. An appropriate cardiovascular assessment is nonetheless mandatory in LT candidates: in fact, during the LT procedure the potential candidate has to tolerate minutes (or even hours) of tachycardia, critical hypotension, severe anemia, and acidosis, conditions that only patients with a perfect cardiac status may tolerate and survive unscathed. In spite of the differences in protocols reported by different centers or countries, the most relevant “pillars” are common across the various stepwise paradigms (electrocardiography, baseline echocardiography): stress tests in high risk candidates are still relevant, but noninvasive imaging (mainly coronary computed tomography angiography) or, in the near future, new forms of stress imaging (stress cardiac magnetic resonance) will be given the appropriate and logical space in the stepwise algorithms for the LT population: the main aim of this crucial work-up is to select the right candidate for the graft, this precious and finite resource able to save and change lives.

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Acknowledgements

Thanks to Rosa Sicari, MD, PhD, for the fruitful discussion and the competent and useful suggestions.

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Authors and Affiliations

  1. Division of Anesthesia and Intensive Care 2, Niguarda Hospital, Milan, Italy

    Andrea De Gasperi, Ernestina Mazza & Pietro Molinari

  2. Unit of Anesthesia and Critical Care for General, Vascular and Transplantation Surgery, Pisa University Hospital, Pisa, Italy

    Gianni Biancofiore

Authors
  1. Andrea De Gasperi
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  2. Gianni Biancofiore
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  3. Ernestina Mazza
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  4. Pietro Molinari
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Corresponding author

Correspondence to Andrea De Gasperi .

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Editors and Affiliations

  1. Department of Surgery, Oncology and Gastroenterology, University of Padua, Hepatobiliary Surgery and Liver Transplant Unit, Padua University Hospital, Padua, Italy

    Umberto Cillo

  2. Department of General Surgery and Transplantation, Niguarda Hospital, School of Medicine and Surgery University of Milano-Bicocca, Milan, Italy

    Luciano De Carlis

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De Gasperi, A., Biancofiore, G., Mazza, E., Molinari, P. (2020). Liver Transplantation as a Challenge for the Anesthesiologist: Preoperative Cardiac Assessment to Orient the Perioperative Period. In: Cillo, U., De Carlis, L. (eds) Liver Transplantation and Hepatobiliary Surgery. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19762-9_21

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  • DOI: https://doi.org/10.1007/978-3-030-19762-9_21

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-19762-9

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