Severe left-sided heart failure early after liver transplantation.
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.
Service de Cardiologie et Maladies Vasculaires (Centre d'Investigation Clinique-Innovations Technologiques 804, Institut National de la Santé et de la Recherche Médicale Unité 642), Centre Hospitalier Universitaire Rennes, Rennes, France.
Frédéric
F
Schnell
Erwan
E
Donal
Richard
R
Lorho
Sylvain
S
Lavoué
Arnaud
A
Gacouin
Philippe
P
Compagnon
Karim
K
Boudjema
Philippe
P
Mabo
Yves
Y
Le Tulzo
Christophe
C
Camus
D000368:Aged; D002319:Cardiovascular System; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007239:Infections; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome