Tandon M, Karna ST, Pandey CK, Chaturvedi R. Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series. World J Hepatol 2017; 9(33): 1253-1260 [PMID: 29312528 DOI: 10.4254/wjh.v9.i33.1253]
Corresponding Author of This Article
Manish Tandon, Associate Professor of Anesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant kunj, New Delhi 110070, India. manishtandon25@rediffmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Manish Tandon, Sunaina Tejpal Karna, Chandra Kant Pandey, Ravindra Chaturvedi, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Tandon M conceived and wrote the manuscript and did literature search and review; Karna ST contributed to this work and did review of literature; Pandey CK and Chaturvedi R contributed equally to this work and reviewed the manuscript, provided intellectual inputs and edited the draft manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Institute of Liver and Biliary Sciences Institutional Review Board vide letter No. F.25/5/107/ILBS/AC/2016/11252/511 dated 01/05/2017.
Informed consent statement: Not applicable.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manish Tandon, Associate Professor of Anesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant kunj, New Delhi 110070, India. manishtandon25@rediffmail.com
Telephone: +91-987-1437478 Fax: +91-114-6300010
Received: May 4, 2017 Peer-review started: May 10, 2017 First decision: June 30, 2017 Revised: September 1, 2017 Accepted: September 15, 2017 Article in press: September 15, 2017 Published online: November 28, 2017
Abstract
Heart failure (HF) following liver transplant (LT) surgery is a distinct clinical entity with high mortality. It is known to occur in absence of obvious risk factors. No preoperative workup including electrocardiogram, echocardiography at rest and on stress, reasonably prognosticates the risk. In patients of chronic liver disease, cirrhotic cardiomyopathy, alcoholic cardiomyopathy, and stress induced cardiomyopathy have each been implicated as a cause for HF after LT. However distinguishing one etiology from another not only is difficult, several etiologies may possibly coexist in a given patient. Diagnostic dilemma is further compounded by the fact that presentation and management of HF irrespective of the possible underlying cause, remains the same. In this case series, 6 cases are presented and in the light of existing literature modification in the preoperative workup are suggested.
Core tip: Heart failure following liver transplant surgery occurs in absence of any obvious risk factors and is associated with high mortality. No preoperative workup including electrocardiogram, echocardiography at rest and on stress, reasonably prognosticates the risk. While cirrhotic cardiomyopathy, alcoholic cardiomyopathy, and stress induced cardiomyopathy each have been implicated, distinguishing one from another is difficult and several etiologies may possibly coexist. In this case series, 6 cases are presented and in the light of existing literature modification in the preoperative workup are suggested.
