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Updated: Jun 28, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Temporary cardiac pacing for fatal arrhythmia in living-donor liver transplantation: three case reports
T Kobayashi1, Y Sato, S Yamamoto
1Division of Digestive and General Surgery, Niigata University Graduate School of medical and Dental Sciences, Niigata, Japan.
Insights
Temporary cardiac pacing is crucial for managing severe arrhythmias during liver transplantation. Early intervention can stabilize patients, though outcomes vary, highlighting the need for vigilant cardiac monitoring in liver transplant recipients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Severe arrhythmias pose a significant risk during liver transplantation.
- Cardiac pacing is a vital treatment for life-threatening arrhythmias.
Observation:
- Three living-donor liver transplantation (LDLT) recipients experienced severe perioperative arrhythmias requiring temporary cardiac pacing.
- One patient with a high MELD score developed a myocardial abscess and died despite pacing.
- Two patients, one with atrial fibrillation and another with bradycardia, survived and recovered with pacing.
Findings:
- Temporary cardiac pacing was successfully employed in LDLT recipients experiencing severe arrhythmias.
- Outcomes were influenced by factors such as infection, MELD score, and underlying cardiac conditions.
- Prompt pacing helped manage hemodynamic instability in patients with arrhythmias.
Implications:
- Early cardiac pacing can be life-saving in liver transplant recipients with severe arrhythmias.
- Vigilant cardiac monitoring and preparedness for pacing are essential in LDLT perioperative care.
- Further research into risk factors and optimal pacing strategies in LDLT is warranted.
Abstract:
Cardiac pacing often turns out to be the only effective treatment of severe, life-threatening arrhythmias. We performed 77 living-donor liver transplantations (LDLT) from 1999 to 2007. In these cases, three recipients experienced fatal arrhythmia and required temporary cardiac pacing during the perioperative period. The first case was a 68-year-old woman diagnosed with liver cirrhosis and hepatocellular carcinoma (HCC). Her Model for End-Stage Liver Disease (MELD) score was 34. We performed LDLT using a right lobe graft. She showed complete atrioventricular block with cardiac arrest at postoperative day (POD) 42 after a bacterial infection. We performed a resuscitation and instituted temporary cardiac pacing. However, she was dead at POD 43. Pathologic findings at autopsy showed a diffuse myocardial abscess, which caused the fatal arrhythmia. The second case was a 58-year-old man diagnosed with HCC and liver cirrhosis; his MELD score was 9. We performed LDLT using a right lobe graft. He showed atrial fibrillation after septic shock. He also showed sinus bradycardia with a cardiac arrest at POD 10. We performed resuscitation and emergent temporary pacing. He recovered and was alive without recurrence of arrhythmia or infection. The third case was a 58-year-old woman diagnosed with multiple HCC. During preoperative regular check-up, she was diagnosed to have cardiac hypertrophy and was started on beta-blockers as treatment for cardiac hypertrophy. However, severe bradycardia necessitated temporary cardiac pacing. LDLT was performed safely after implantation of a pacemaker. Early use of temporary cardiac pacing for severe arrhythmias may be effective to maintain the hemodynamic state in LDLT.
