Management of patients with cardiopulmonary comorbidities awaiting liver transplantation

PURPOSE OF REVIEW: The need for liver transplant continues to rise especially among those with metabolic dysfunction associated steatotic liver disease. Consequently, more transplant candidates have concurrent cardiopulmonary comorbidities. This review summarizes contemporary developments in cardiopulmonary care in liver transplant candidates. RECENT FINDINGS: Recent guidelines recommend noninvasive anatomic cardiovascular assessment before invasive coronary angiography for evaluation of coronary artery disease. Post-PCI DAPT can be used for as short as 1 month before waitlist activation. Practice-based guidance recommends echocardiographic surveillance on the waitlist especially with the evolving data on the impact of Cirrhotic Cardiomyopathy. Emerging evidence suggests that guideline directed medical therapy for heart disease is safe in patients with advanced liver disease. Updated portopulmonary hypertension guidelines emphasize revised screening and diagnostic thresholds, early initiation of medical therapy, and timely liver transplant evaluation. SUMMARY: Management of cardiopulmonary comorbidities in liver transplant candidates continues to advance yet remains nuanced requiring a multidisciplinary approach for optimal care.