Cardiac failure after liver transplantation requiring a biventricular assist device

Area of Science:

• Hepatology
• Cardiology
• Transplantation

Background:

• Increased hepatic iron load in extrahepatic organs is linked to poorer long-term prognosis in cirrhotic patients undergoing liver transplantation.
• Hepatic and non-hepatic iron overload correlate with higher rates of infectious and postoperative complications, including cardiac dysfunction.

Purpose of the Study:

• To report a case of a cirrhotic patient with alpha 1 antitrypsin deficiency and nonhereditary hemochromatosis (non-HFE) who experienced cardiogenic shock post-liver transplant due to significant iron deposition.
• To emphasize the importance of identifying extrahepatic iron deposition preoperatively in liver transplant candidates.

Main Methods:

• Case report detailing a cirrhotic patient with alpha 1 antitrypsin deficiency and nonhereditary hemochromatosis.
• Inclusion of liver and heart biopsies to assess iron deposition.
• Management with mechanical circulatory support for cardiogenic shock.

Main Results:

• The patient developed cardiogenic shock requiring mechanical biventricular support for twenty days post-liver transplant.
• Biopsies confirmed significant iron deposition in both the liver and heart.
• Complete and sustained cardiac recovery was achieved after ten days of mechanical support.

Conclusions:

• Preoperative recognition of extrahepatic iron deposition is vital in patients referred for liver transplantation, regardless of liver disease etiology.
• Identifying iron overload can help prevent severe postoperative complications, such as cardiogenic shock.