Living Donor Liver Transplantation in Children With Congenital Heart Disease

Concejero, Allan M.; Chen, Chao‐Long; Liang, Chi-Di; Wang, Chih‐Chi; Wang, Shih-Ho; Lin, Chih‐Che; Liu, Yeuh-Wei; Yong, Chee‐Chien; Yang, Chien‐Hsin; Lin, Tsan‐Shiun; Jawan, Bruno; Huang, Tung‐Liang; Cheng, Yu‐Fan; Eng, Hock‐Liew

doi:10.1097/01.tp.0000277599.25079.94

Cited by 11 publications

(14 citation statements)

References 18 publications

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“…There are case reports of iatrogenic venous air embolism, with right-to-left shunting of emboli across a PFO during LT (90,91). The overall incidence of this complication appears to be quite low (isolated case reports), and liver transplantation for the most part can be performed safely in patients with a PFO and other types of intracardiac shunts (92). Although the presence of a PFO is not a contraindication to LT, extra care should be taken to prevent thrombus formation and air entry into the venous system during surgery.…”

Section: Patent Foramen Ovalementioning

confidence: 82%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

229

174

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Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.

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Section: Patent Foramen Ovalementioning

confidence: 82%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

229

174

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“…End‐stage liver disease is associated with cardiovascular abnormalities such as increased cardiac output, lower systemic blood pressure, and decreased peripheral vascular resistance. However, the coexistence of end‐stage liver disease and CHD is rare in the LT setting …”

Section: Introductionmentioning

confidence: 99%

Outcomes of liver transplantation in pediatric recipients with cardiovascular disease

Brito

Neto

Fonseca

et al. 2017

Pediatric Transplantation

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LT exerts considerable stress on the heart perioperatively. Limited data exist on impact of cardiovascular diseases on LT children. This study evaluated the outcomes of children with CVD who underwent LT and compared with pretransplant findings. From 518 LT recipients, 82 (15.8%) had CVD. Sixty patients were classified as low-risk adjustment for congenital heart surgery 1 (RACHS 1 and 2). Five patients were classified as RACHS ≥3. The most common echocardiographic finding in the CVD patients (25/82) was ASD. CVD patients had more abnormal EKG (32.4% vs 14.5%, P < .001), abnormal chest X-ray (11.8% vs 1.4%, P < .001), and altered echocardiography (89.7% vs 15.4%, P < .001) findings compared with the No-CVD group pretransplant. Post-transplant, significant differences between groups were observed related to abnormal EKG (14.7% vs 7.0%, P = .03) and echocardiography (48.5% vs 3.2%, P < .01) findings. Pretransplant ASD spontaneously closed in 22 patients. At 1 and 5 years post-transplant, there was no difference in the survival rate between groups (P = .96). The prevalence of CVD in recipients of LT was high, and its presence was associated with significantly higher cardiac decompensation before and after LT. Minor and moderate cardiovascular disease did not impact the long-term survival.

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“…Raichlin et al reported the results of combined heart and liver transplantation and found no difference in survival in comparison with heart transplantation alone. However, when combined heart and liver transplantation is not an option or an indication, deciding what comes first should take into consideration the risks of worsening liver function after a cardiac repair versus the development of the aforementioned complications in a patient with heart disease . In our case, the cardiac malformation demanded early intervention.…”

Section: Discussionmentioning

confidence: 93%

“…The majority of reports on LT and CHD involve patients with Alagille syndrome, and the usual CHDs are pulmonary stenosis and aortic stenosis . Other centers have performed deceased donor LT and living donor liver transplantation (LDLT) for patients with CHD (Table ), and some have not found an increase in morbidity or mortality . In a case‐control study, however, no correction of the heart condition was attempted before LT, and there were no intraoperative cardiac complications; this suggested that every patient had compensated heart disease at the time of LT.…”

Section: Discussionmentioning

confidence: 99%

“…When CHD and end‐stage liver disease are combined, it is a matter of debate whether LT should come first, cardiac repair should come first, or the 2 procedures should be performed at the same time . Raichlin et al reported the results of combined heart and liver transplantation and found no difference in survival in comparison with heart transplantation alone.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation after stage II palliation for hypoplastic left heart syndrome

et al. 2013

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The association of biliary atresia (BA) with congenital heart diseases has been extensively described, and there are a number of reports on the outcomes of patients in this group who undergo liver transplantation (LT). The intraoperative management and the timing of LT for patients with end-stage liver disease are matters of debate, especially when complex heart diseases are involved. This report describes the outcome after LT for a pediatric recipient with BA and hypoplastic left heart syndrome. The patient underwent Norwood-Sano and Glenn procedures for heart palliation before LT. He was cyanotic, was severely malnourished, and had complications secondary to chronic liver failure. At the time of transplantation, the child was 16 months old and weighed 5175 g. Despite the critical clinical scenario and the long hospitalization period, there were no cardiac, vascular, or biliary complications after LT. At the age of 48 months, the patient was awaiting the final cardiac repair. In conclusion, the presence of complex cardiac malformations may not be a contraindication to LT. An experienced surgical team and a multidisciplinary approach are key to a successful outcome.

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Living Donor Liver Transplantation in Children With Congenital Heart Disease

Abstract: LDLT is a safe procedure in a select group of ESLD patients with CHD.

Cited by 11 publications

References 18 publications

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Outcomes of liver transplantation in pediatric recipients with cardiovascular disease

Liver transplantation after stage II palliation for hypoplastic left heart syndrome

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