Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver Transplantation: A Retrospective Observational Study

Jang, Dong-Min; Jun, In‐Gu; Moon, Young‐Jin; Shin, Won-Jung; Song, Jae-Kwan; Hwang, Gyu‐Sam

doi:10.1016/j.transproceed.2016.08.049

Cited by 11 publications

(19 citation statements)

References 27 publications

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“…In adults, systolic dysfunction in cirrhosis is defined as decreased ejection fraction and blunted cardiac output in response to stressors, which has not reliably been demonstrated in children. (14,15) In contrast, an elevated SF, which is more in line with the hyperdynamic state found in adults with cirrhosis at rest, was demonstrated in children. (2,4,11,15,38) Our primary aim was to derive a set of consistent, easily obtainable, and pediatric specific 2DE parameters that better identified adverse events associated with ESLD secondary to BA.…”

Section: Discussionmentioning

confidence: 73%

“…This made it essential to determine the method, among BSA (g/m 2 ) or height 2.7 (g/m 2.7 ), with the greatest predictive validity for adverse outcomes in this population. In adults, systolic dysfunction in cirrhosis is defined as decreased ejection fraction and blunted cardiac output in response to stressors, which has not reliably been demonstrated in children . In contrast, an elevated SF, which is more in line with the hyperdynamic state found in adults with cirrhosis at rest, was demonstrated in children …”

Section: Discussionmentioning

confidence: 99%

“…Of those 3, 1 patient had two events (these were: hemorrhage and tracheostomy), and 2 patients had three events (hemorrhage, tracheostomy, and HD on discharge for both). Those [10][11][12][13][14]; P = 0.17), though greater, were not statistically significant.…”

Section: Association Of Ba-ccm With Outcomes: Mortality Csae and Losmentioning

confidence: 94%

“…Unlike in adults, CCM remains relatively unrecognized and understudied in children, with little appreciation for the devastating clinical consequences associated with it. This, in part, stems from the lack of a specific pediatric diagnostic criteria . Although optimal methods for evaluating and diagnosing adult CCM continue to evolve, current guidelines utilize echocardiographic parameters to quantify the systolic and diastolic dysfunction characteristics of this disease.…”

mentioning

confidence: 99%

“…This, in part, stems from the lack of a specific pediatric diagnostic criteria. (2,(13)(14)(15) Although optimal methods for evaluating and diagnosing adult CCM continue to evolve, (16) current guidelines utilize echocardiographic parameters to quantify the systolic and diastolic dysfunction characteristics of this disease. Among these parameters are a decreased early to late phase diastolic filling velocity (E/A ratio), and prolonged isovolumetric and deceleration times to identify diastolic dysfunction, and a decreased ejection fraction to identify systolic dysfunction.…”

mentioning

confidence: 99%

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Clinical Consequences of Cardiomyopathy in Children With Biliary Atresia Requiring Liver Transplantation

et al. 2019

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Association Of Ba-ccm With Outcomes: Mortality Csae and Losmentioning

confidence: 94%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Consequences of Cardiomyopathy in Children With Biliary Atresia Requiring Liver Transplantation

et al. 2019

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Features of Cirrhotic Cardiomyopathy Early in the Lives of Infants With Biliary Atresia Correlate With Outcomes Following Kasai Portoenterostomy

et al. 2022

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Cirrhotic cardiomyopathy (CCM), detected during two‐dimensional echocardiography (2DE), is prevalent in patients with biliary atresia (BA) awaiting transplant. Whether CCM occurs early in the lives of infants with BA is unknown. The aim of this study was to explore the incidence and consequence of CCM in patients with BA, focusing on the earliest ages when 2DE was performed. A cohort of 78 patients with BA at a single center underwent 2DE (median age = 132 days) during the first year of life. Left ventricular mass index (LVMI) to upper limit of normal (ULN) ratio ≥ 1.0 was present in 60% of patients who never underwent Kasai portoenterostomy (KPE; n = 15), 49% with nondraining KPE (n = 41), and 21% with draining KPE (n = 19). Patients with a draining KPE (median age at 2DE = 72 days) had a lower LVMI/ULN ratio (0.75 [interquartile range [IQR] 0.70, 0.91]) compared to those with a nondraining KPE (0.99 [IQR 0.78, 1.17] median age of 141 days; P = 0.012). In those whose 2DE was performed within 7 days of KPE (n = 19, median age of 61 days), the LVMI/ULN ratio was lower in those with a future draining KPE (0.73 [IQR 0.66, 0.75]) compared to the group with a future nondraining KPE (1.03 [IQR 0.88, 1.08], P = 0.002). Logistic regression modeling revealed LVMI/ULN ratio ≥ 1.0 as a predictor of KPE outcome, with an odds ratio of 16.7 (95% confidence interval 1.36‐204; P = 0.028) for a future nondraining KPE compared to those with a LVMI/ULN ratio < 1.0. Conclusion: 2DE early in the lives of patients with BA revealed features of CCM that correlated with future outcomes. If validated in a multicenter study, this could lead to 2DE as a useful clinical tool in the care of infants with BA.

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Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes

Junge¹,

Junge

Schröder³

et al. 2018

Liver Transpl

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In adults, cirrhotic cardiomyopathy (CCM) has a significant incidence and impact on liver transplantation. For pediatric liver transplantation (pLT), data on liver-induced cardiac changes are scarce, and in particular, the comparison between cirrhotic and noncirrhotic liver disease has not been investigated. We retrospectively evaluated cardiac changes associated with CCM by echocardiography and 12-lead electrocardiogram in 198 pLT-candidates (median age 4.1 years) 4.2 before and 12 months after pLT. Results were correlated with the stage of liver fibrosis and cholestasis before transplantation. The left ventricular end-diastolic diameter (LVIDd) z score, left ventricular mass z score, and left ventricular mass index were significantly higher in cirrhotic patients (-0.10 versus 0.98, P < 0.001; -1.55 versus -0.42, P = 0.001; 78.99 versus 125.64 g/m , P = 0.001, respectively) compared with children with noncirrhotic liver disease. Pathological z scores (>2SDS) for the LVIDd occurred more frequently in cirrhotic patients compared with patients with noncirrhotic liver disease (31/169 versus 1/29; P = 0.03) and were significantly associated with cholestasis. All observed cardiac changes were reversible 1 year after pLT. Pathological LVIDd z scores correlated highly with intensive care unit (ICU) stay (9.6 days versus 17.1 days, respectively, P = 0.002) but not with patient survival pre-LT or post-LT. In contrast to other studies, prolonged QTc time was not associated with liver cirrhosis in our patients. In conclusion, CCM-associated cardiac changes in pLT candidates with cirrhotic liver disease are frequent, mild, and associated with cholestasis and reversible after pLT. They may impact peritransplant care and posttransplant hospitalization time. Further prospective evaluation is warranted. In particular, for QTc time prolongation etiological factors, possible protective effects of ursodeoxycholic acid treatment and the use as a screening parameter for CCM should be verified. Liver Transplantation 24 820-830 2018 AASLD.

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Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver Transplantation: A Retrospective Observational Study

Cited by 11 publications

References 27 publications

Clinical Consequences of Cardiomyopathy in Children With Biliary Atresia Requiring Liver Transplantation

Clinical Consequences of Cardiomyopathy in Children With Biliary Atresia Requiring Liver Transplantation

Features of Cirrhotic Cardiomyopathy Early in the Lives of Infants With Biliary Atresia Correlate With Outcomes Following Kasai Portoenterostomy

Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes

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