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Post-liver transplantation myocardial dysfunction

P Sampathkumar1, A Lerman, B Y Kim

  • 1Divisions of Critical Care, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|September 2, 1998
PubMed
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Liver transplant recipients can develop reversible dilated cardiomyopathy post-surgery. This condition, characterized by reduced ejection fraction, improved with supportive care, suggesting increased peripheral resistance as a potential cause.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Medicine

Background:

  • End-stage liver disease often presents with hyperdynamic circulation.
  • Myocardial depression post-liver transplantation is linked to increased organ failure and mortality.
  • Reversible dilated cardiomyopathy is a potential complication in liver transplant recipients.

Purpose of the Study:

  • To investigate the incidence and characteristics of reversible dilated cardiomyopathy in the early post-liver transplantation period.
  • To identify potential causes and outcomes of this cardiac dysfunction.

Main Methods:

  • Retrospective review of 754 adult liver transplant patients.
  • Identification of patients with initial hyperdynamic circulation followed by cardiac dysfunction.

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  • Exclusion of other causes of cardiac dysfunction (ischemia, thyroid, electrolytes).
  • Echocardiographic assessment of left ventricular ejection fraction and chamber dimensions.

    • Main Results:

    • Seven patients developed reversible dilated cardiomyopathy post-transplantation.
    • Left ventricular ejection fraction decreased from a median of 60% to 20% (P = .02).
    • All patients required intensive supportive care, including mechanical ventilation and inotropic support.
    • Cardiac function improved to a median ejection fraction of 50% in all patients.
    • No recurrence of heart failure at 15-month follow-up.

    Conclusions:

    • Reversible dilated cardiomyopathy can occur in liver transplant recipients.
    • Increased peripheral resistance post-transplantation may contribute to this condition.
    • Prompt supportive care leads to favorable outcomes and recovery of cardiac function.