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Living Donor Liver Transplantation in a Cohort of Recipients With Left Ventricular Systolic Dysfunction
Pooja Bhangui1, Prashant Bhangui2, Manish Aneja1
1Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India.
Insights
Living donor liver transplantation (LDLT) is feasible in select patients with left ventricular systolic dysfunction (LVSD). Careful risk stratification is crucial for patients with LVSD, coronary artery disease (CAD), or cirrhotic cardiomyopathy (CCM) undergoing LDLT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Limited data exists on liver transplantation (LT) outcomes in patients with left ventricular systolic dysfunction (LVSD), severe coronary artery disease (CAD), or cirrhotic cardiomyopathy (CCM).
- Understanding the feasibility and management of LT in these high-risk cardiac populations is critical for improving patient outcomes.
Purpose of the Study:
- To review the outcomes of living donor liver transplantation (LDLT) in recipients with pre-existing LVSD.
- To assess the feasibility, management strategies, and survival rates in this specific patient cohort.
Main Methods:
- A retrospective review of 1946 LDLT cases performed between July 2010 and July 2018.
- Identification and analysis of recipients with LVSD (ejection fraction [EF] < 50%), including those with concurrent CAD or CCM.
Main Results:
- Twelve male patients with LVSD underwent LDLT; 6 had CAD and 6 had CCM. Ethanol was the primary cause of cirrhosis in 50% of cases.
- Perioperative complications included ventricular ectopic rhythm and stress cardiomyopathy; 30-day and 1-year mortality were 16.7% and 25%, respectively.
- Five-year survival was 66%, with no long-term cardiac deaths observed. Higher MELD scores and extreme BMI were associated with mortality.
Conclusions:
- LDLT can be considered for carefully selected LT candidates with LVSD, stable CAD, and well-optimized CCM.
- Thorough risk stratification and management in experienced centers are essential for successful LDLT in patients with cardiac compromise.
Background:
Data on feasibility, management, and outcomes of liver transplantation (LT) in patients with pre-existing left ventricular systolic dysfunction (LVSD), severe coronary artery disease (CAD) or cirrhotic cardiomyopathy (CCM) is scarce.
Methods:
We reviewed outcomes of living donor liver transplantation (LDLT) in recipients with LVSD (ejection fraction [EF] < 50%) from our series of 1946 LDLT's performed between July 2010 and July 2018.
Results:
LVSD was detected in 12 male patients with a mean age, BMI and MELD of 52 ± 9 years, 25 ± 5 kg/m2, and 19 ± 4 respectively. Out of these, 6 patients had CAD (2 with previous coronary artery bypass graft, 1 following recent percutaneous transluminal coronary angioplasty, 2 post myocardial infarction, 1 noncritical CAD), and 6 had CCM. The EF ranged from 25% to 45%. Ethanol was the predominant underlying etiology for cirrhosis (50%). During LDLT, 2 patients developed ventricular ectopic rhythm and were managed successfully with intravenous lidocaine. Stress cardiomyopathy manifested in 3 patients post operatively with decreased EF, of which 2 improved, while 1 needed IABP support and succumbed to multiorgan failure on 8th postoperative day (POD). Another patient died on POD30 due to septic shock. Both these patients had higher MELD scores (actual MELD), extremes of BMI (17.3and 35.8 kg/m2) and were diabetic. There were no long-term cardiac deaths. The 1-year, and 5-year survival were 75%, and 66%, respectively.
Conclusion:
Among potential LT recipients with LVSD, those with stable CAD and good performance status, and well optimized CCM patients may be considered for LDLT after careful risk stratification in experienced centers.
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