Yataco Maria L, Difato Thomas, Bargehr Johannes, Rosser Barry G, Patel Tushar, Trejo-Gutierrez Jorge F, Pungpapong Surakit, Taner C Burcin, Aranda-Michel Jaime
Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA.
Liver Int. 2014 Jul;34(6):e105-10. doi: 10.1111/liv.12501. Epub 2014 Mar 15.
BACKGROUND & AIMS: Non-ischaemic cardiomyopathy (NIC) is an early complication of liver transplantation (LT). Our aims were to define the prevalence, associated clinical factors, and prognosis of this condition.
A retrospective study was performed on patients undergoing LT at our institution from January 2005 to December 2012. Patients who developed NIC were identified. Data collected included demographic and clinical data.
A total 1460 transplants were performed in this period and seventeen patients developed NIC. Pretransplant median QTc interval was 459 (range, 405-530), and median E/A ratio was 1 (range, 0.71-1.67). Fourteen patients (82%) were severely malnourished and required nutritional support. Thirteen patients (76%) had renal insufficiency. Median time to onset was 2 days post-transplant (range, 0-20). Echocardiograms showed global left ventricular hypokinesis and a decrease in ejection fraction (EF) from a median of 65% (range, 50-81) pretransplant to a median of 21% (range, 15-32). Median raw model for end-stage liver disease (MELD) score was 29 in patients with NIC vs. 18 in patients without cardiomyopathy (P = 0.01). There was no significant difference between recipients with NIC vs. recipients without cardiomyopathy regarding donor age, donor risk index, and cold and warm ischaemia time. Recovery of cardiac function occurred in 16 patients, with a median EF of 44% (range, 25-65%) at the time of discharge. The last echocardiogram available showed a median EF of 59% (range, 49-73%). One-year survival of NIC patients was 94.1%.
Non-ischaemic cardiomyopathy is a rare complication after LT. Patients with NIC are critically ill, with high MELD score, and severe malnutrition.
非缺血性心肌病（NIC）是肝移植（LT）的早期并发症。我们的目的是明确该疾病的患病率、相关临床因素及预后。
对2005年1月至2012年12月在我院接受肝移植的患者进行回顾性研究。确定发生NIC的患者。收集的数据包括人口统计学和临床数据。
在此期间共进行了1460例移植手术，17例患者发生了NIC。移植前QTc间期中位数为459（范围405 - 530），E/A比值中位数为1（范围0.71 - 1.67）。14例患者（82%）严重营养不良，需要营养支持。13例患者（76%）存在肾功能不全。发病的中位时间为移植后2天（范围0 - 20天）。超声心动图显示左心室整体运动减弱，射血分数（EF）从中位数65%（范围50 - 81%）移植前降至中位数21%（范围15 - 32%）。NIC患者终末期肝病模型（MELD）评分中位数为29，无心肌病患者为18（P = 0.01）。在供体年龄、供体风险指数以及冷、热缺血时间方面，发生NIC的受者与未发生心肌病的受者之间无显著差异。16例患者心功能恢复，出院时EF中位数为44%（范围25 - 65%）。最后一次可用超声心动图显示EF中位数为59%（范围49 - 73%）。NIC患者1年生存率为94.1%。
非缺血性心肌病是肝移植后一种罕见的并发症。NIC患者病情危重，MELD评分高，且严重营养不良。
