Torsades de Pointes Triggered by Severe Diastolic Hypotension With Low Hematocrit in the Neohepatic Stage of Liver Transplantation: A Case Report

Abstract

We have described herein a 39-year-old male patient with hepatitis B virus-related cirrhosis (Child class C), showing a prolonged corrected QT interval, who developed torsades de pointes (TdP) in the neohepatic stage of liver transplantation (LT). There was no arrhythmia in the pre-anhepatic and anhepatic stages. Multiple premature ventricular complexes, ventricular tachycardia, and TdP suddenly developed at 16 minutes after graft reperfusion without any prodromal arrhythmia; they persisted for 118 seconds. Laboratory tests showed that serum potassium, calcium, and magnesium concentrations of 4.7 mmol/L, 1.05 mmol/L, and 1.85 mg/dL, respectively were within normal ranges. Likely causative factors for TdP in this patient included a prolonged corrected QT interval (553 msec), a low hematocrit (21%), and a low arterial blood pressure (systolic blood pressure, 80–90 mm Hg; diastolic blood pressure; 20–26 mm Hg) in the neohepatic stage. This case demonstrated the importance of optimal maintenance of coronary perfusion, with an adequate hematocrit level and electrolyte concentrations, to prevent the development of TdP in cirrhotic patients with a prolonged corrected QT interval during LT.