Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes

Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes In adults, cirrhotic cardiomyopathy (CCM) has a significant incidence and impact on liver transplantation. For pediatric liver transplantation (pLT), data on liver‐induced cardiac changes are scarce, and in particular, the comparison between cirrhotic and noncirrhotic liver disease has not been investigated. We retrospectively evaluated cardiac changes associated with CCM by echocardiography and 12‐lead electrocardiogram in 198 pLT‐candidates (median age 4.1 years) 4.2 before and 12 months after pLT. Results were correlated with the stage of liver fibrosis and cholestasis before transplantation. The left ventricular end‐diastolic diameter (LVIDd) z score, left ventricular mass z score, and left ventricular mass index were significantly higher in cirrhotic patients (‐0.10 versus 0.98, P < 0.001; ‐1.55 versus ‐0.42, P = 0.001; 78.99 versus 125.64 g/m2, P = 0.001, respectively) compared with children with noncirrhotic liver disease. Pathological z scores (>2SDS) for the LVIDd occurred more frequently in cirrhotic patients compared with patients with noncirrhotic liver disease (31/169 versus 1/29; P = 0.03) and were significantly associated with cholestasis. All observed cardiac changes were reversible 1 year after pLT. Pathological LVIDd z scores correlated highly with intensive care unit (ICU) stay (9.6 days versus 17.1 days, respectively, P = 0.002) but not with patient survival pre‐LT or post‐LT. In contrast to other studies, prolonged QTc time was not associated with liver cirrhosis in our patients. In conclusion, CCM‐associated cardiac changes in pLT candidates with cirrhotic liver disease are frequent, mild, and associated with cholestasis and reversible after pLT. They may impact peritransplant care and posttransplant hospitalization time. Further prospective evaluation is warranted. In particular, for QTc time prolongation etiological factors, possible protective effects of ursodeoxycholic acid treatment and the use as a screening parameter for CCM should be verified. Liver Transplantation 24 820–830 2018 AASLD. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes

Download PDF
11 pages
Read Article

Loading next page...
 
/lp/wiley/pediatric-cirrhotic-cardiomyopathy-impact-on-liver-transplant-outcomes-jkneLi3XQU
Publisher
Wiley
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
DOI
10.1002/lt.25076
Publisher site
See Article on Publisher Site

Abstract

In adults, cirrhotic cardiomyopathy (CCM) has a significant incidence and impact on liver transplantation. For pediatric liver transplantation (pLT), data on liver‐induced cardiac changes are scarce, and in particular, the comparison between cirrhotic and noncirrhotic liver disease has not been investigated. We retrospectively evaluated cardiac changes associated with CCM by echocardiography and 12‐lead electrocardiogram in 198 pLT‐candidates (median age 4.1 years) 4.2 before and 12 months after pLT. Results were correlated with the stage of liver fibrosis and cholestasis before transplantation. The left ventricular end‐diastolic diameter (LVIDd) z score, left ventricular mass z score, and left ventricular mass index were significantly higher in cirrhotic patients (‐0.10 versus 0.98, P < 0.001; ‐1.55 versus ‐0.42, P = 0.001; 78.99 versus 125.64 g/m2, P = 0.001, respectively) compared with children with noncirrhotic liver disease. Pathological z scores (>2SDS) for the LVIDd occurred more frequently in cirrhotic patients compared with patients with noncirrhotic liver disease (31/169 versus 1/29; P = 0.03) and were significantly associated with cholestasis. All observed cardiac changes were reversible 1 year after pLT. Pathological LVIDd z scores correlated highly with intensive care unit (ICU) stay (9.6 days versus 17.1 days, respectively, P = 0.002) but not with patient survival pre‐LT or post‐LT. In contrast to other studies, prolonged QTc time was not associated with liver cirrhosis in our patients. In conclusion, CCM‐associated cardiac changes in pLT candidates with cirrhotic liver disease are frequent, mild, and associated with cholestasis and reversible after pLT. They may impact peritransplant care and posttransplant hospitalization time. Further prospective evaluation is warranted. In particular, for QTc time prolongation etiological factors, possible protective effects of ursodeoxycholic acid treatment and the use as a screening parameter for CCM should be verified. Liver Transplantation 24 820–830 2018 AASLD.

Journal

Liver Transplantation – Wiley

Published: Jan 1, 2018

References

  • Is there a cirrhotic cardiomyopathy?
    Blendis, L; Wong, F
  • Cardiovascular complications of cirrhosis
    Møller, S; Henriksen, JH
  • Bile acid excess induces cardiomyopathy and metabolic dysfunctions in the heart
    Desai, MS; Mathur, B; Eblimit, Z; Vasquez, H; Taegtmeyer, H; Karpen, SJ
  • Bile acids and cardiovascular function in cirrhosis
    Voiosu, A; Wiese, S; Voiosu, T; Bendtsen, F; Møller, S
  • Prevalence and outcome of diastolic dysfunction in liver transplantation recipients
    Raevens, S; Pauw, M; Geerts, A; Berrevoet, F; Rogiers, X; Troisi, RI
  • Prevalence and impact on survival of hepatopulmonary syndrome and cirrhotic cardiomyopathy in a cohort of cirrhotic patients
    Voiosu, AM; Daha, IC; Voiosu, TA; Mateescu, BR; Dan, GA; Baicus, CR
  • Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis
    Alexopoulou, A; Papatheodoridis, G; Pouriki, S; Chrysohoou, C; Raftopoulos, L; Stefanadis, C
  • Preoperative left ventricular hypertrophy is associated with reduced patient survival after liver transplantation
    Darstein, F; Konig, C; Hoppe‐Lotichius, M; Grimm, D; Knapstein, J; Mittler, J
  • Prolongation of QTc interval: relationship with etiology and severity of liver disease, mortality and liver transplantation
    Bal, JS; Thuluvath, PJ
  • Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue doppler imaging
    Fattouh, AM; El‐Shabrawi, MH; Mahmoud, EH; Ahmed, WO
  • Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe
    Kampmann, C; Wiethoff, CM; Wenzel, A; Stolz, G; Betancor, M; Wippermann, CF
  • A novel method of expressing left ventricular mass relative to body size in children
    Foster, BJ; Mackie, AS; Mitsnefes, M; Ali, H; Mamber, S; Colan, SD
  • Cardiac structural and functional alterations in infants and children with biliary atresia, listed for liver transplantation
    Desai, MS; Zainuer, S; Kennedy, C; Kearney, D; Goss, J; Karpen, SJ
  • Cirrhotic Cardiomyopathy: Getting to the Heart of the Matter
    Ma, Z; Lee, SS
  • A study of heart disease in one hundred eight hospitalized patients dying with portal cirrhosis
    Lunseth, JH; Olmstead, EG; Abboud, F
  • The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
    Elm, E; Altman, DG; Egger, M; Pocock, SJ; Gotzsche, PC; Vandenbroucke, JP
  • Histological grading and staging of chronic hepatitis
    Ishak, K; Baptista, A; Bianchi, L; Callea, F; Groote, J; Gudat, F
  • Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension
    Celtik, C; Durmaz, O; Oner, N; Yavuz, T; Gokce, S; Aydogan, A
  • Impact of liver transplantation on rate‐corrected QT interval and myocardial function in children with chronic liver disease*
    Arikan, C; Kilic, M; Tumgor, G; Levent, E; Yuksekkaya, HA; Yagci, RV
  • QTc interval prolongation and hepatic encephalopathy in patients candidates for liver transplantation: a valid inference?
    Marafioti, V; Benetti, V; Montin, U; Carbone, V; Petrosino, A; Tedeschi, U
  • Prevalence, risk factors and in‐hospital outcomes of QTc interval prolongation in liver cirrhosis
    Zhao, J; Qi, X; Hou, F; Ning, Z; Zhang, X; Deng, H
  • QT Interval: metric for cardiac prognosis?
    Lehmann, MH; Morady, F
  • Heart and bile acids ‐ clinical consequences of altered bile acid metabolism
    Vasavan, T; Ferraro, E; Ibrahim, E; Dixon, P; Gorelik, J; Williamson, C
  • Impact and persistence of cirrhotic cardiomyopathy after liver transplantation
    Sonny, A; Ibrahim, A; Schuster, A; Jaber, WA; Cywinski, JB
  • Pretransplant left ventricular dysfunction adversely affects perioperative outcomes in pediatric liver transplantation: a retrospective observational study
    Jang, DM; Jun, IG; Moon, YJ; Shin, WJ; Song, JG; Hwang, GS

You’re reading a free preview. Subscribe to read the entire article.

Try 2 weeks free now

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

or browse the journals available

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create folders to
organize your research

Export folders, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off

Sign up
for free
Start 14 day
Free Trial