Acute beriberi following liver transplantation

Area of Science:

• Cardiology
• Hepatology
• Nutritional Science

Background:

• Orthotopic liver transplantation (OLT) requires thorough preoperative cardiac evaluation.
• End-stage liver disease and alcoholism can predispose patients to nutritional deficiencies.
• Routine cardiac assessments may not identify subclinical thiamine deficiency.

Purpose of the Study:

• To report a case of acute pulmonary edema post-OLT due to beriberi.
• To highlight the importance of thiamine status in OLT candidates.
• To suggest routine thiamine supplementation in OLT patients.

Main Methods:

• Case report of a 32-year-old male undergoing OLT.
• Diagnostic confirmation of beriberi using the thiamine diphosphate effect.
• Clinical assessment of response to intravenous thiamine therapy.

Main Results:

• The patient developed acute pulmonary edema on postoperative day two, despite a normal preoperative cardiac workup.
• Beriberi was diagnosed and confirmed through biochemical tests and therapeutic response.
• Intravenous thiamine administration led to a dramatic recovery.

Conclusions:

• Thiamine deficiency (beriberi) can manifest as acute pulmonary edema post-OLT.
• Preoperative cardiac screening may miss thiamine deficiency in at-risk patients.
• Routine thiamine supplementation should be considered for all OLT patients, especially those with a history of alcohol abuse.