Table 2.

Comorbidity assessment in liver transplant candidates.

Comorbidity	Procedure	Associated risk
Cardiovascular	ECG, heart ultrasound with Doppler ergometry or pharmacological stress test (>50 years or with multiple cardiovascular risk factors for coronary heart disease), coronary angiography (with positive ergometry test or pharmacological stress test)	In the case of adequately treated coronary heart disease, the risk is equal to the rest of the population, for recipients aged >70 years increased cardiovascular risk
Respiratory	Chest X-ray, spirometry, diffusion capacity for CO, the definition of hepatopulmonary syndrome (HPS; calculation of alveolar/arterial oxygen gradient or contrast echocardiography) and portopulmonary hypertension (PPHTN; mean pulmonary artery pressure—MPAP >30 mmHg, right-sided cardiac catheterization is obligatory)	For HPS and pO2 <50 mmHg without response to 100% oxygen therapy—possible irreversible respiratory failure not corrected with LT, for PPHTN and MPAP ≥35 mmHg not responding to pulmonary vasodilator therapy—high perioperative mortality MPAP 35–50 mmHg—50% risk of mortality after LT [59] MAP >50 mmHg absolute contraindication for LT—100% risk of posttransplantation mortality [59]
Renal	Abdominal and kidney ultrasound, spot urine test, K/Na/protein/creatinine in daily urine, eGFR (MDRD6)	Sevenfold increased perioperative risk recipients with GFR <30 mL/min or hepatorenal syndrome and dialysis >8–12 weeks or >30% glomerulosclerosis or fibrosis on kidney biopsy—simultaneous liver and kidney transplantation indicated
Nutritive status	Body mass index (BMI), prealbumin, psoas thickness (MSCT)	Recipients with a BMI <18.5 or >40 have elevated mortality
Osteoporosis	Densitometry	Osteoporotic fracture (fractures of the hip, vertebrae, and distal forearm are the most common)
Infections	The first level of screening consists of screening for human immunodeficiency virus (HIV) 1 and 2 antibodies, HBV serology, HCV antibodies, HAV antibodies, cytomegalovirus (CMV), and completing a chest X-ray [51] The second level of screening consists of screening for Mycobacterium tuberculosis (history + PPD-Mantoux + IFN gamma release assays), Epstein–Barr virus (EBV), human herpes virus 8 (HHV-8), varicella-zoster virus (VZV), herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), urine culture, parasitological examination and stool culture (Strongyloides stercoralis serology, Toxoplasma gondii IgG, Treponema pallidum serology), Immunoenzymatic Assay with Venereal Disease Research Laboratory (VDRL), Staphylococcus aureus nasal/axillary swab, and dentist review recipients should receive the vaccine for HAV, HBV, chickenpox, pneumococcus, influenza, tetanus, COVID-19	Uncontrolled sepsis, bacterial, viral, and invasive fungal infections (aspergillosis) are a contraindication for the LT procedure