Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 28, 2017; 9(33): 1253-1260
Published online Nov 28, 2017. doi: 10.4254/wjh.v9.i33.1253
Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series
Manish Tandon, Sunaina Tejpal Karna, Chandra Kant Pandey, Ravindra Chaturvedi
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:
Correspondence to: Manish Tandon, Associate Professor of Anesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant kunj, New Delhi 110070, India.
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
Case characteristics

Patients of acute liver failure and of chronic liver disease, presenting with systolic heart failure within 7 d after the liver transplant surgery in absence of any preoperatively identified and obvious predisposing risk factor.

Clinical diagnosis

Systolic heart failure was diagnosed on basis of clinical presentation and echocardiography with greatly reduced left ventricle ejection fraction.

Differential diagnosis

Liver graft dysfunction and severe sepsis may cause hemodynamic instability and were ruled out. Underlying cause for the observed systolic heart failure could not be made.

Laboratory diagnosis

Creatine kinase-MB was elevated upon diagnosis of systolic heart failure after liver transplant. Troponin T sensitive card test was negative.

Imaging diagnosis

Severely reduced left ventricle ejection fraction was diagnosed on echocardiography.

Pathological diagnosis

Could not be made conclusively.


Respiration was assisted. Hemodynamics supported using inotropes and inodilators and beta blockers, aimed at preload and after load reduction. Sedation and analgesia were taken care of to reduce sympathetic adrenergic activity.

Term explanation

Cirrhotic cardiomyopathy and alcohol cardiomyopathy have been described as specific clinical entities that describe cardiomyopathy in setting of underlying chronic liver disease and with history of alcohol indulgence respectively. Acute broken heart syndrome describes the cardiomyopathy typically seen under stressful conditions and not necessarily after surgery and is said to resemble acute myocardial infarction.

Experiences and lessons

In absence of established clinical features and limitations of existing prevalent diagnostic modalities, Bio-chemical makers like BNP and Troponin I may be routinely done as part of preoperative workup of patients posted for liver transplant surgery to help identify patients at greater risk of heart failure after the surgery.