Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series

Area of Science:

• Cardiology
• Hepatology
• Transplantation Surgery

Background:

• Heart failure (HF) post-liver transplant (LT) presents a significant clinical challenge with high mortality rates.
• HF can occur without identifiable preoperative risk factors, complicating early detection and management.
• Existing preoperative workups, including ECG and echocardiography, have limited prognostic value for HF after LT.

Observation:

• Patients with chronic liver disease may develop HF due to cirrhotic, alcoholic, or stress-induced cardiomyopathy.
• Distinguishing between these etiologies is difficult, and multiple conditions can coexist.
• The clinical presentation and management of HF post-LT are often similar regardless of the underlying cause.

Findings:

• This case series highlights 6 instances of HF following LT.
• The study underscores the diagnostic challenges in identifying the specific cause of HF post-LT.
• Current preoperative assessments are insufficient for predicting HF risk in LT candidates.

Implications:

• Modified preoperative workup strategies are proposed to better assess HF risk in LT candidates.
• Improved diagnostic tools are needed to differentiate etiologies of HF post-LT.
• Addressing HF in LT recipients requires a nuanced approach considering potential coexisting cardiomyopathies.