POST-LIVER TRANSPLANTATION MYOCARDIAL DYSFUNCTION

Patients with end-stage liver disease usually show a hyperdynamic circ ulatory state. It has previously been reported that patients who devel op myocardial depression in the early post-liver transplantation perio d are more prone to organ failure and death. We reviewed the records o f 754 adult patients undergoing liver transplantation at our instituti on and identified 7 patients who initially showed hyperdynamic circula tion, but then developed reversible dilated cardiomyopathy in the earl y posttransplantation period. All identifiable causes of cardiac dysfu nction, such as myocardial ischemia, thyroid dysfunction, and electrol yte imbalances, were excluded. Left ventricular ejection fraction decr eased from a preoperative median baseline of 60% to 20% (P = .02), wit h four-chamber dilatation on echocardiogram. All these patients requir ed supportive care, including mechanical ventilation, afterload reduct ion, inotropic support, and monitoring in the intensive care unit. Car diac 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 recurr ence of heart failure. The increased peripheral resistance seen after successful liver transplantation may be an important causative factor. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.