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Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver
D-M Jang1, I-G Jun1, Y-J Moon1
1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Pretransplant left ventricular diastolic dysfunction (LVDD) and elevated myocardial performance index (MPI) in pediatric liver transplant (LT) recipients are linked to worse perioperative outcomes, including longer hospital stays and increased lactate accumulation.
Area of Science:
- Cardiology
- Pediatric Hepatology
- Transplantation Medicine
Background:
- Left ventricular diastolic dysfunction (LVDD) is common in adult cirrhotic cardiomyopathy and predicts poor outcomes after liver transplantation (LT).
- The impact of pretransplant cardiac dysfunction on perioperative outcomes in pediatric LT recipients is largely unknown.
Purpose of the Study:
- To investigate the prevalence of pretransplant cardiac dysfunction in pediatric LT recipients.
- To determine if pretransplant LVDD and myocardial performance index (MPI) affect perioperative outcomes in this population.
Main Methods:
- Retrospective analysis of clinical and Doppler echocardiographic data from 45 pediatric LT recipients (2007-2013).
- LVDD defined by cirrhotic cardiomyopathy criteria; MPI measured using tissue Doppler imaging.
- Comparison of intraoperative data and postoperative hospitalization duration.
Main Results:
- LVDD observed in 13% and MPI ≥0.5 in 27% of pediatric LT recipients.
- Patients with MPI ≥0.5 had significantly higher end-operative lactate levels (2.48 vs 0.82).
- Longer hospital stays were associated with LVDD (46 vs 30 days) and MPI ≥0.5 (38 vs 29 days).
Conclusions:
- Pretransplant LVDD appears less prevalent in pediatric LT recipients (13%) compared to adults.
- Cardiac dysfunction, indicated by LVDD and elevated MPI, adversely impacts perioperative outcomes in pediatric LT.
- Cautious perioperative monitoring is recommended for pediatric LT recipients with pre-existing LVDD or elevated MPI.
Background:
Although left ventricular diastolic dysfunction (LVDD) is a pronounced feature of adult cirrhotic cardiomyopathy and a major predictor of poor outcomes following liver transplantation (LT), little is known about if pretransplant cardiac dysfunction affects perioperative outcomes in pediatric LT.
Methods:
We retrospectively evaluated pretransplant clinical and Doppler echocardiographic data for 45 consecutive pediatric LT recipients who were treated between 2007 and 2013 (median age = 15 months; interquartile range = 9 to 78 months). LVDD was defined according to the cirrhotic cardiomyopathy criteria, and the myocardial performance index (MPI) was measured using tissue Doppler imaging. Intraoperative data and hospitalization days following LT were compared.
Results:
LVDD and MPI ≥0.5 (defined as a z score ≥2) were observed in 13% and 27% of patients, respectively. Patients with an MPI ≥0.5 demonstrated the increased accumulation of lactate at the end of their LT operation (mean = 2.48 vs 0.82; P = .026) compared with patients with an MPI <0.5. The hospital stay was longer in patients with LVDD (median = 46 days vs 30 days; P = .041) and patients with an MPI ≥0.5 (median = 38 days vs 29 days; P = .014) compared with patients without LVDD and MPI <0.5, respectively.
Conclusions:
LVDD might be less prevalent (13%) in pediatric patients compared with adults. However, pretransplant cardiac dysfunction in patients with LVDD and an MPI ≥0.5 adversely affects perioperative outcomes, necessitating that such pediatric LT recipients be cautiously observed perioperatively.
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