2. Reversible non-ischemic cardiomyopathy after orthotopic liver transplantation: a report of case series from single-center experience

Abstract

Background: Non-ischaemic cardiomyopathy (NIC) is an early complication of liver transplantation (LT). Patients undergoing LT at our institution from September 2014 to April 2018. Patients who developed NIC were identified. Data collected included demographic and clinical data. Case Summary: A total 31 transplants were performed in this period and three patients developed NIC. Pretransplant dobutamine stress echocardiography was negative and Ejection fraction showed good LV systolic function. 25 patients (82%) were severely malnourished and required nutritional support. Median time to onset was 2 days post-transplant (range, 0–20). Echocardiograms showed global left ventricular hypokinesis and a decrease in ejection fraction (EF) from a median of 74% (range, 66–78) pretransplant to a median of 30% (range, 30–35). There was no significant difference between recipients with NIC vs. recipients without cardiomyopathy regarding donor age, donor risk index, and cold and warm ischemia time. Recovery of cardiac function occurred in all 3 patients, with a median EF of 60% (range, 58–62%) at the time of discharge. One-year survival of NIC patients was 100%. Conclusion: patients who developed NIC were individuals who had advanced liver disease with a high MELD score. The etiology of NIC is unknown, but it is most likely multifactorial. Although NIC is a rare complication of LT, and in most cases it is reversible, it can also cause significant post-operative morbidity requiring significant physiological support, a prolonged hospital stay, or mortality. Conclusions: Recognition of individuals at risk of NIC in the pre- or immediately post-LT period may be beneficial in reducing cardiovascular complications and may improve outcomes. The authors have none to declare.