Document Detail


Severe left-sided heart failure early after liver transplantation.
MedLine Citation:
PMID:  19790149     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Left-sided heart failure (LHF) after liver transplantation (LT) is rare and poorly understood. We performed a case-control study. We reviewed the data of all patients with LHF after LT at our center from November 2000 to July 2007. Each case was matched to 1 LT control without LHF for age, sex, date of transplantation, and liver disease. Twenty of 599 patients developed LHF (3.3%). Pretransplant cardiovascular characteristics and risk factors were similar in cases and controls, except for the prevalence of left ventricular enlargement, which was greater in controls. At the time of diagnosis, the median left ventricular ejection fraction was 25% in cases, and increased afterload was documented by markedly elevated vascular resistances. The prevalence of infection at the time of LHF in cases was higher (55%) than in controls (10%, P = 0.02). The reported causes of LHF were infection [bacterial (n = 1) or viral (n = 7)], intraoperative cardiac arrest (n = 2), and unknown (n = 10). In comparison with their controls, cases with immediate postoperative LHF (day 0) did not have a higher Model for End-Stage Liver Disease (MELD) score (15 versus 21.5) or infection prevalence rate (17% versus 34%), whereas those with later onset LHF had a significantly higher MELD score (25.5 versus 17, P = 0.01) and infection prevalence rate (71% versus 0%, P = 0.002). Mortality was 45% in cases versus 0% in controls (P = 0.004), and the 11 cases who survived recovered from LHF. In conclusion, LHF after LT carries a high mortality risk and may have different causes. Except for immediate postoperative cases, an infection and an elevated MELD score appear to be determinant.
Authors:
Fr??d??ric Schnell; Erwan Donal; Richard Lorho; Sylvain Lavou??; Arnaud Gacouin; Philippe Compagnon; Karim Boudjema; Philippe Mabo; Yves Le Tulzo; Christophe Camus
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  15     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-05     Completed Date:  2009-12-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1296-305     Citation Subset:  IM    
Copyright Information:
Copyright 2009 AASLD
Affiliation:
Service de Cardiologie et Maladies Vasculaires (Centre d'Investigation Clinique-Innovations Technologiques 804, Institut National de la Sant?? et de la Recherche M??dicale Unit?? 642), Centre Hospitalier Universitaire Rennes, Rennes, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiovascular System
Case-Control Studies
Electrocardiography
Female
Heart Failure / diagnosis*,  etiology*
Heart Ventricles / pathology
Humans
Infection
Liver Transplantation / adverse effects*,  methods*
Male
Middle Aged
Postoperative Period
Prevalence
Retrospective Studies
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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