Echocardiographic findings of hypertrophic cardiomyopathy in children after orthotopic liver transplantation

This study was carried out to compare echocardiographic findings of childre n taking tacrolimus and cyclosporin A (CsA) after orthotopic liver transpla ntation (OLT). Echocardiograms of 19 children were reviewed during hospital izations after OLT, and echocardiograms were performed on 23 children who r eturned to the clinic for a routine follow-up visit after OLT. Measurements were made of the left ventricle (LV) end-diastolic dimension, and of the t hickness of the LV free wall (LVFW) and the inter-ventricular septum (IVS). From these measurements, the LV mass was calculated. LV outflow; gradient was measured by using Doppler interrogation. Comparisons were made between patients on CsA and patients on tacrolimus, Children with hypertrophic card iomyopathy (HCM) were identified. Two patients from the in-patient tacrolim us group were found to have HCM. These two patients had asymmetric septal h ypertrophy with dynamic LV outflow obstruction and were successfully treate d with propranolol, with or without discontinuing tacrolimus. In the out-pa tient studies, there was no difference in LVFW and IVS thickness, or LV mas s index, between children on CsA and children on tacrolimus. Hence, tacroli mus is associated with the development of HCM in children. The effect of ta crolimus on HCM development may be acute and temporary. More data are neede d to determine the incidence of HCM in children on tacrolimus therapy and t o establish guidelines for clinicians who followup these children.