title: Cardiac failure after liver transplantation requiring a biventricular assist device.
abstract: Increased hepatic iron load in extrahepatic organs of cirrhotic patients with and without hereditary hemochromatosis portends a poorer long term prognosis after liver transplant. Hepatic as well as nonhepatic iron overload is associated with increased infectious and postoperative complications, including cardiac dysfunction. In this case report, we describe a cirrhotic patient with alpha 1 antitrypsin deficiency and nonhereditary hemochromatosis (non-HFE) that developed cardiogenic shock requiring mechanical circulatory support for twenty days after liver transplant. Upon further investigation, she was found to have significant iron deposition in both the liver and heart biopsies. Her heart regained complete and sustained recovery following ten days of mechanical biventricular support. This case highlights the importance of preoperatively recognizing extrahepatic iron deposition in patients referred for liver transplantation irrespective of etiology of liver disease as this may prevent postoperative complications.
authors.affiliation: Division of Heart Failure, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Rita
authors.identifier: 0000-0001-7249-7755
authors.initials: R
authors.lastname: Jermyn
authors.affiliation: Division of Hepatology, Department of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Eiei
authors.initials: E
authors.lastname: Soe
authors.affiliation: Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: D'Alessandro
authors.affiliation: Division of Heart Failure, Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Jakobleff
authors.affiliation: Department of Pathology, Montefiore Medical Center, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Division of Hepatology, Department of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.affiliation: Division of Hepatology, Department of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gaglio