EFFECT OF LIVER-TRANSPLANTATION ON QT INTERVAL PROLONGATION AND AUTONOMIC DYSFUNCTION IN END-STAGE LIVER-DISEASE

Both a prolonged QT interval and disturbance of autonomic nervous syst em function are markers of poor prognosis in patients with diabetes me llitus and alcoholic liver disease (ALD). We studied the prevalence of abnormal QT interval and autonomic nervous system dysfunction in 53 c onsecutive patients with end-stage liver disease before and after orth otopic liver transplantation (OLT), The maximum QT interval in any lea d (QT(max)) was assessed by two independent observers. The QT(max), co rrected for heart rate (QT(cmax)) was prolonged in 44 patients (83%), although increased QT dispersion was not found. There was a significan t correlation between the QT(cmax) and Child-Pugh score but not with e tiology. Evidence of parasympathetic dysfunction was present in 41 pat ients (77%), and sympathetic dysfunction was present in 20 patients be fore OLT. Fifty-two patients underwent transplantation. There was sign ificant improvement in the QT(cmax) interval after OLT (P < .001); 32 of the 44 patients with prolonged QT(cmax) (>440 milliseconds) improve d. Repeat testing was not performed in 7 patients, because they had di ed or had not undergone transplantation indices of parasympathetic fun ction improved in 27 patients after OLT, but no improvement was observ ed in 8. Improvement in sympathetic dysfunction was observed in 13 of the 19 patients tested. There was no association between QT(cmax) auto nomic dysfunction, and survival. These results suggest that both prolo nged QT(cmax) and some tests of autonomic function are temporary and a rise as a consequence of Liver dysfunction.