Post-liver transplantation myocardial dysfunction

Patients with end-stage liver disease usually show a hyperdynamic circulato ry state. It has previously been reported that patients who develop myocard ial depression in the early post-liver transplantation period are more pron e to organ failure and death. We reviewed the records of 754 adult patients undergoing liver transplantation at our institution and identified 7 patie nts who initially showed hyperdynamic circulation, but then developed rever sible dilated cardiomyopathy in the early posttransplantation period. All i dentifiable causes of cardiac dysfunction, such as myocardial ischemia, thy roid dysfunction, and electrolyte imbalances, were excluded. Left ventricul ar ejection fraction decreased from a preoperative median baseline of 60% t o 20% (P = .02), with four-chamber dilatation on echocardiogram. All these patients required supportive care, including mechanical ventilation, afterl oad reduction, inotropic support, and monitoring in the intensive care unit . Cardiac function subsequently improved in all patients, with ejection fra ction increasing to a median of 50%. All patients were discharged from the hospital. At a median follow-up of 15 months, there was no recurrence of he art failure. The increased peripheral resistance seen after successful live r transplantation may be an important causative factor. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.