Perforated meckel's diverticulum in a 3-day-old neonate; a case report

Perforation of Meckel's diverticulum is a rare complication in neonatal period. A 3-day-old term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel's diverticulum was detected. Pathological reportofthe tissue showed inflamed diverticulum withheterotopic gastric muco-sa. This is the first report of Meckel's diverticulum perforation inaneonate in our country

Serologic evaluation of celiac disease in patients with beta thalassemia major and control

This study reports evaluated prevalence of CD in patients with Beta-thalassemia major. Celiac Disease [CD] is an autoimmune disorder triggered by ingestion of gluten in genetically predisposed individuals. In this case-control study in a period of 3 years, which was performed on 620 children in two groups of Beta-thalassemia major patients [n=200] and control [n=420], serum tissue transglutamianse [tTG] IgA levels were measured. The two groups were compared together in terms of tTG IgA levels, and p<0.05 was considered significant. The means of serum tTG IgA levels in patients with Beta-thalassemia major and control groups were 28.81+/-68.44 and 6.94+/-6.68 U/mL, respectively. There was a significant difference in favor of the case group [p=0.000]. Body mass index in the two case and control groups had a significant difference [t=3.859, p=0.001]. Belonging to each group will change the probability of having less than 20 in tTG IgA [odds=0.285] and it means that belonging to the control group has a protective role. There is only a significant association in the case of all population [r=0.102, p=0.011]. Body mass index in the two case and control groups had a significant difference [t=3.859, p=0.001]. Probability of CD should be considered since the prevalence of CD is high in patients with and Beta-thalassemia major. Patients with thalassemia major are recommended for screening for CD

Common polymorphisms of ATP7B gene as a good marker in linkage analysis in Wilson disease patients from Southern Iran

Background: Wilson disease [WD] is caused by numerous pathogenic mutations of the ATP7B gene. There are several mutation screening methods that can be used for the diagnosis and carrier detection of WD, however such methods are costly and time-consuming. Therefore, other diagnostic methods should be used for urgent situations such as prenatal diagnosis

Objective: To report common polymorphisms of ATP7B gene in WD patients from southern Iran to be use in linkage analysis in the WD affected families

Material and methods: Genomic DNA was extracted from 30 patients and PCR was carried out for ATP7B gene. DHPLC was then performed and PCR products with abnormal peak profiles were subjected to direct DNA sequencing

Result: Several patients showed abnormal peak profiles in DHPLC analysis and subsequent sequencing results demonstrated that some polymorphisms were more common in southern Iran. Those were c.1216T>G [exon 2], c.1366C>G [exon 3], c.3419 T>C [exon 16], c.3903 + 6C>T [intron 18] and c.4021+50G>C [intron 19]

Conclusion: These common polymorphisms can be used by linkage analysis for the prenatal diagnosis and carrier detection in affected families with Wilson disease

Clinical manifestations among children with chronic functional constipation

Constipation is one of the most frequent cause of patient visits to pediatric gastroenterology clinics. Early diagnosis and treatment is important. There are few studies about clinical manifestations of constipation in children. We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children. This cross-sectional study was carried out on children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences. Children with organic causes of chronic constipation were excluded from study. Rome III criteria were used for defining constipation. The duration of study was 1 year starting from September 2010. Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and pen-anal erythema were recorded for each case based on history and physical examination. Data were analyzed using SPSS software, version 13.0 [Chicago, IL, USA]. Of 222 children with functional constipation, 124[55.9%] were girls and 98 [44.1%] were boys with a mean +/- SD age of 5 +/- 3.12 years. The mean +/- SD duration of constipation was 2.2 +/- 1.9 years. Large and hard stool was present in 93.7% of the patients. Painful defecation and withholding behavior were seen in 92.3% and 91.9% of the patients, respectively. Fecal impaction was more frequent among boys compared with girls [p<0.01]. Fecal soiling was present in 40.8% of the boys and 28.2% of the girls [p=0.04]. Large and hard stool, painful defecation and withholding behavior were the most frequent signs or symptoms among children with chronic functional constipation. Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group

Evaluation of cholestasis in Iranian infants less than three months of age

The aim of this study is to find-out the possible etiologies in Iranian infants less than three months in Shiraz, South of Iran. Cholestatic jaundice most probably occurs due to a pathological condition and the most frequent causes in early infancy are neonatal hepatitis and biliary atresia. Early diagnosis and treatment of infantile cholestasis can improve prognosis of liver diseases by prevention of the complications of these disorders. In this retrospective study, 122 infants under 3 months of age with cholestasis were studied in Nemazee Hospital [affiliated to Shiraz University of Medical Sciences] during the years 2001-2011. Demographic data, duration of jaundice, liver biopsy and the causes of cholestasis were recorded. There were 76 males [62.3%] and 46 females [37.7%] with a mean age of 54.4 +/- 23.7 days. The most common clinical finding was jaundice that was seen in all patients [100%].The onset of jaundice was the first day to the fifty two days of age, with an average age of 15.6 +/- 16.1 days. Other findings included hepatomegaly in 92 patients [76.4%], clay-color stool in 54 [44.3%], and splenomegaly in 29 patients [23.8%]. In this study, the most common causes of cholestasis were biliary atresia [30=24.6%], idiopathic neonatal hepatitis [30= 24.6%] and bile ducts paucity [16=10.3]. The results of this study showed that biliary atresia and neonatal hepatitis are the most common cause infantile cholestasis in this area. It is recommended that biliary atresia should be discriminated from other form of neonatal cholestasis

Combination of erythromycin and propranolol for treatment of childhood cyclic vomiting syndrome: a novel regimen

This study aimed to evaluate the erythromycin efficacy in childhood cyclic vomiting syndrome. Cyclic vomiting syndrome [CVS] is an unusual cause of episodic emesis in children and erythromycin is an effective treatment. In this prospective study, 301 patients with a final diagnosis of CVS enrolled in two separated groups. The first group received erythromycin for 7 days and propranolol for at least 9 months [n=155]. The second group was treated with propranolol alone for at least 9 months [n=146]. These two groups were compared for response to the treatment and the recurrence of symptoms after treatment completion. Relationship of response, recurrence, and characteristics of the disease was assessed. Both groups showed a significant difference in terms of response to treatment [P=0.002], however the recurrence after treatment completion had no considerable difference [P=0.563]. There was no relationship between CVS characteristics and these two items [response and recurrence]. In our point of view, the addition of erythromycin to standard propranolol treatment can improve the response to treatment, although it has no significant effect on recurrence of CVS symptoms. We suggest the use of erythromycin for 7 days in addition to CVS standard therapy

Serological evaluation of celiac disease in children with congenital heart defect; a case control study

Due to the increased prevalence of celiac disease in chromosomal anomalies and other congenital anomalies, this study was conducted to evaluate the seroprevalence of celiac disease [CD] in patients with congenital heart defects [CHD]. This case-control study was done on 1002 children in two groups of CHD patients [n=402] and controls [n=600]. The serum tissue transglutamianse [TTG] levels were investigated. The two groups were compared in terms of TTG IgA levels and p<0.05 was considered as the significant level. The means of serum TTG IgA levels in children with CHD and the control groups were 19.17 +/- 46.67 and 7.77 +/- 10.02 u/mL respectively [p=0.001]. After ANOVA analysis a significant difference between two cyanotic and acyanotic subgroups of cases and control groups was observed [p=0.000]. The follow up tukey test showed only non-significant difference between the cyanotic and acyanotic cases. The frequency of TTG IgA with the consideration of 20 u/mL as cut-off point showed a significant association with groups [X2=28.31 and p=0.000]. According to the results the serum TTG IgA levels were significantly higher in patients with CHD than normal children and screening for CD in children with CHD is recommended

Complications of blind versus ultrasound-guided percutaneous liver biopsy in children

Background and study aims: Liver biopsy is a well-established procedure in the diagnosis and follow-up of liver diseases. Complications of liver biopsy are rare but potentially lethal. The aim of this study was to evaluate the complications of percutaneous liver biopsy and to compare the complications of blind and ultrasound-guided percutaneous liver biopsy in paediatric wards of Nemazee Hospital of Shiraz in the south of Iran

Patient and method: To complete the questionnaire, registered information of liver biopsies due to different causes in paediatric patients between 2008 and 2012 was retrospectively reviewed. All children aged between 0 and 18 years, who underwent liver biopsy [due to any indication], participated in this study

Results: Liver biopsies were obtained from 210 patients. Seven of 210 cases were excluded due to unreliable data. A total of 209 liver biopsies were done in the rest of the cases [n = 203]. Of all cases of liver biopsies, 22 [10.5%] experienced complications after biopsy. Pain [n = 7] was the most frequent complication in 22 cases of liver biopsy. Mortality rate was one [0.5%] due to rupture of subcapsular haematoma. In terms of complication [p = 0.592], there was no significant difference statistically between patients with blind liver biopsy [n = 16] and patients with ultrasound-guided liver biopsy [n = 6]

Conclusion: In terms of complications, there was no significant difference when the patients were evaluated with and without ultrasound-guided biopsy

Intestinal pseudo-obstruction as an unusual gastrointestinal presentation in pediatric human immunodeficiency virus infection

Intestinal pseudo-obstruction is a condition in which the intestine's ability to push food through is reduced. It often leads to the dilation of the various parts of the bowel. It can be idiopathic or inherited from a parent, or caused by another disease. We report a rare case of human immunodeficiency virus [HIV] infection in a 3-year-old boy who referred with acute abdominal pain, and was later diagnosed as having intestinal pseudo-obstruction caused by HIV. The underlying causes of intestinal pseudo-obstruction should be taken into account. HIV induced pseudo-obstruction may be considered in the differential diagnosis of pediatric intestinal pseudo-obstruction in order to provide a timely diagnosis and optimal care of children with HIV

Epidemiology of pediatric acute poisoning in southern Iran: a hospital-based study

To determine the epidemiology of acute childhood poisoning in Shiraz, southern Iran. This was a prospective cross-sectional descriptive study, being performed in Nemazee and Dastgheib Hospitals affiliated with Shiraz University of Medical Sciences. The study included pediatric patients [<18 years]referred to our centers due to acute poisoning. Demographic and etiological factors were prospectively recorded and analyzed. A total of 773 patients with mean age of 3.86 +/- 1.5 years were recruited in the study. The most common group which included 352 [45.5%] patients, aged between 8 months and 5 years followed by 330 [42.6%] cases aged from 12-18 years. In majority of cases, poisoning was due to opium in 222 [23.5%] followed by analgesics in 181 [19.1%], which mostly included acetaminophen in 75 [7.9%], anti-depressants in 170 [17.9%], anti-hypertensive drugs in 65 [6.8%] and hydrocarbons in 60 [6.3%]. There were 260 [33.7%] boys and 513 [66.3%] girls. The poisoning occurred inadvertently in 387 [50.1%] cases while 298 [38.5%] patients committed suicide. Most cases [255 patients; 32.9%] were asymptomatic at presentation. Our study substantiated the following findings: A] Alarmingly, opium is the most common cause of acute childhood poisoning in our area. B] Easy access to toxic material is the most common risk factor for acute childhood poisoning. C] Female predominance of acute childhood poisoning accompanied by high rate of suicidal attempts shows that psychiatric problems, especially depression is most common among young girls

Clinical characteristics of pediatric esophagitis in southern iran; asingle-center experience

Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran

Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients [<18 years] who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients' demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire

Results: We studied 125 children, comprising 61 [48.8%] girls and 64 [51.2%] boys at a mean age of 6.6 +/- 5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 [60%] patients, followed by fever in 35 [28%]. Erythema [33.6%], esophageal ulcer [11.2%], and whitish patch [8.0%] were the most common endoscopic findings, while reflux esophagitis [32.8%], chronic [6.4%] and acute esophagitis [5.6%], and candida esophagitis [5.6%] were the most common histological diagnoses. Only one [0.8%] patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft versushost disease

Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression

Autoimmune hepatitis in children: experiences in a tertiary center

Autoimmune hepatitis [AIH] is a necroinflammatory liver disease of unknown etiology that occurs in the children of all ages. The present study aimed to evaluate the clinical and paraclinical presentations, including pattern of autoantibodies, response to treatment, mortality, and liver transplantation outcome in the Iranian children with AIH. The medical records of 87 children [56 girls and 31 boy] diagnosed with AIH between 2001 and 2010 were retrospectively analyzed for clinical and paraclinical profiles and also treatment outcome. The mean age of the patients was 10.1 +/- 4.5 years [64.4% females]. The most common clinical findings were jaundice [70.1%], splenomegaly [67.8%], and hepatomegaly [51.7%]. Antinuclear, anti-smooth muscle, and anti LKM antibodies were positive in 14/62, 22/53 and 6/40 patients, respectively [36 patients had type 1 AIH, 6 patients had type 2 AIH, 26 patients were seronegative, and autoantibodies were not available in 19 cases]. The most common histological finding in the liver biopsies was chronic hepatitis with interface activity that was seen in 65 [74.7%] patients. The complete response was seen in 52 [59.8%] patients and 24 [27.6%] patients underwent liver transplantation. One-year and five-year survival rates were 87.5% and 80% in the transplanted patients. AIH should be kept in mind in the differential diagnosis of both acute and chronic liver diseases in the children and treatment with combination of corticosteroids and azathioprine is a good treatment option. In the patients with end stage liver cirrhosis that did not respond to medical therapy, liver transplantation is the treatment of choice

Etiology and complications of liver cirrhosis in children: report of a single center from southern Iran

Liver cirrhosis is one of the major causes of hospitalization and mortality in children. A wide spectrum of disorders including developmental abnormalities, infections, metabolic and genetic disorders can lead to liver cirrhosis in pediatric patients. Determination of its etiology is important for treatment modality, prevention of progressive liver damage, family counseling and prioritizing liver transplantation. The aim of this study is to evaluate the causes of liver cirrhosis in children in Southern Iran. We included all cirrhotic children aged less than 18 years who referred to an outpatient Pediatric Gastroenterology Clinic affiliated with Shiraz University of Medical Sciences between March 2009 and September 2010 in this cross-sectional study. The etiology of cirrhosis was determined according to clinical findings, laboratory tests, radiographic evaluation such as ultrasonography or computed tomography scan, hepatobiliary scintigraphy and histopathologic examination of the liver biopsy. Cirrhosis with unknown etiology was considered as cryptogenic. A total of 106 cirrhotic children aged between 5 months to 18 years old with a mean age of 8.24 +/- 6.12 years that included 60 boys [56.6%] and 46 girls [43.4%] were enrolled in the study. The most common causes of liver cirrhosis were Wilson disease [n=22; 20.7%], biliary atresia [n=19; 17.9%], and cryptogenic cirrhosis [n=14; 13.2%]. Other causes were autoimmune hepatitis [n=12; 11.3%], idiopathic neonatal hepatitis [n=10; 9.4%], hepatorenal tyrosinemia [n=9; 8.5%], glycogen storage disease [n=6; 5.7%], and progressive familial intrahepatic cholestasis [n=4; 3.8%].Considering the most common etiology of liver cirrhosis in children in this part of Iran we suggest testing for Wilson disease in all cirrhotic children

Paucity of intrahepatic bile ducts in neonates: the first case series from Iran

Paucity of interlobular bile ducts [PIBD], defined as absence or marked decrease in the number of interlobular bile ducts, is one of the causes of neonatal cholestasis. Treatment includes treating the intractable pruritus caused by persistent cholestasis. PIBD can be part of a familial syndrome of cholestasis named Alagille syndrome [AGS]. We report clinical status of a case series of Iranian patients with PIBD. In this retrospective study, patients with cholestasis admitted to the pediatric gastroenterology ward in a referral hospital in Shiraz from January 2006 to January 2010 and underwent liver biopsy were evaluated. Clinical and paraclinical status of children with the pathologic diagnosis of PIBD was assessed. Disease was presented in all jaundiced patients with aged in average 3 days at presentation. Seven patients had the criteria of AGS. Despite medical treatment, cholestasis was not controlled in 6 [28.6%] patients. Liver transplantation led to the survival of 5 patients while the other patient who did not undergo liver transplantation died at 2 months of age. One patient underwent peritoneal dialysis due to renal insufficiency and died at 9 months of age. After 1-5 years of follow-up, the mortality rate was 9.5%.In patients with intractable cholestasis, only patients that underwent liver transplantation survived. Thus, the most important criterion for liver transplantation in neonatal PIBD is intractable cholestasis. This is the first report that shows AGS can result in neonatal-onset renal insufficiency

Clinical and Para clinical findings in the children with tyrosinemia referring for liver transplantation

Hereditary tyrosinemia type 1 [HT1] is a rare autosomal recessive inborn error of metabolism caused by deficiency of fumarylacetoacetate hydrolase enzyme. This disease manifests with severe liver and kidney impairment and is associated with an increased risk of liver cancer. The aim of this study was to evaluate clinical, laboratory, imaging, and histopathologic characteristics in the children with HT1 who had referred for liver transplantation. The present retrospective study was conducted on 45 children with HT1 who had referred to Organ Transplantation Center affiliated to Shiraz University of Medical Sciences between March 2005 and March 2010. There were 64.4% boys and 35.6% girls with mean age of 3.75 +/- 1.28 year [ranges from 2 months to 13 years]. The most first clinical presentation was hepatic [80%] and the most prevalent physical findings were hepatomegaly [57.8%], splenomegaly [51.1%], ascites [42.2%], and jaundice [37.9%]. The most relevant laboratory parameters were the high serum succinylacetone, alpha-fetoprotein, and tyrosine levels. The most common findings in the patient's abdominal ultrasonography were multiple hepatic nodules [75.6%] and inhomogeneous parenchymal echogenicity of liver [48.9%], while hyper and hypo attenuated nodules [60%] and non-homogeneous pattern of liver parenchyma [53.3%] were the most prevalent findings in abdominal computed tomography scan. In the histopathology of the liver, the most important finding was cirrhosis in all the patients. In this study, 14 patients [31.1%] received Nitisinone [2-[2-nitro- 4-trifluoromethylbenzoyl]-1,3-cyklohexanedione; NTBC]. This study described clinical and laboratory findings in the children with HT1 who had referred for liver transplantation because of end-stage liver disease from all over country, which indicates delay in diagnosis and treatment of this disease. Considering the results of this study, newborn screening for this disease is highly suggested

Epidemiology of pediatric inflammatory bowel diseases in southern Iran

There are great variations in the incidence and prevalence of inflammatory bowel diseases [IBD] among different populations. Epidemiologic studies mainly come from North America and Europe. Studies from Iran are mostly data on the adult population from the northern region of the country. Medical records of 37 pediatric patients [? 18 years of age] admitted in the Pediatric Gastroenterology Ward at Nemazee Hospital, from 2001 through 2007 with final diagnoses of IBD were reviewed regarding data such as clinical manifestations and colonoscopic findings. There were 19 boys [52%] and 18 girls [48%] with a mean age of 10.3 +/- 4.9 years [range: 2-17 years]. Of these, 26 [70%] had ulcerative colitis [UC], 9 [25%] were diagnosed with Crohn's disease [CD], and 2 [5%] were labeled as indeterminate colitis [IC]. Bloody stools [84.6%] and pallor [80.8%] were the most common features in UC whereas growth failure [88.9%] followed by pallor [77.8%] were the most frequent symptoms in patients with CD. The most frequent colonoscopic findings in UC and CD were erythema [80%] and ulcer [71.4%] respectively. This study provides available epidemiologic data on pediatric patients with IBD from Southern Iran

Etiology of lower gastrointestinal bleeding in children: a single center experience from southern Iran

This study aimed to determine the common etiologies and characteristics of lower gastrointestinal [GI] bleeding in children from Southern Iran. This five-year prospective cross-sectional study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric patients [<18 years of age] who referred to our center with gross lower GI bleeding or two consecutive positive occult blood tests with at least a one-week interval were included in the study. Patients were categorized as neonates, infants, children and adolescents and the findings were reported separately in each group. Each patient underwent a colonoscopy and several mucosal biopsies were taken. Demographic and clinical information as well as colonoscopy and pathology findings were reported. Overall, we included 363 pediatric patients with a mean age of 71.9 +/- 58.4 months [range: 1-216 months]. There were 215 [59.2%] boys and 148 [40.8%] girls. The most common colonoscopy findings were sigmoid colon polyp in 91 [25.1%] patients followed by descending colon petechia in 78 [21.5%] patients, whitish rectal lesions in 45 [12.4%] patients, and sigmoid and rectal ulcers in 37 [10.2%] patients. Biopsy samples were non-specific in 96 [26.4%] patients. The most common pathological findings were juvenile polyp in 84 [23.1%] followed by lymphoid nodular hyperplasia in 55 [15.2%] and solitary rectal ulcers in 25 [6.9%] patients. We found that lower GI bleeding was more common among 2-10 year-old children and was rarely encountered in neonates. Hematochezia was the most common form of presentation followed by bloody diarrhea and occult blood. The most common colonoscopy finding was sigmoid colon polyp and the most common pathological finding was juvenile polyp.

role of cow's milk allergy in pediatric chronic constipation: a randomized clinical trial

Cow's milk allergy has different presentations in children and can cause functional bowel symptoms such as chronic constipation. The aims of this study were to investigate the role of cow's milk allergy as a cause of chronic constipation and effect of cow's milk free diet [CMFD] on its treatment in children. We performed a randomized clinical study comparing CMFD with cow's milk diet [CMD] in two groups each consisting of 70 patients [age range, 1-13 years] with chronic functional constipation [defined as Rome III criteria]. All subjects had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives for at least 3 months without success; also all 140 patients performed skin prick test. The case group received CMFD for 4 weeks. After that they received CMD for 2 extra weeks. The control group received CMD for whole 6 weeks. A response was defined as decreased in signs and symptoms that not fulfilled Rome III criteria after 4 weeks of CMFD and came back to Rome III criteria after 2 weeks of CMD challenge. After 4 weeks 56 [80%] patients of the case group responded in comparison to 33 [47.1%] patients in the control group [P=0.0001]. In the case group after 2 weeks challenge 24 out of 56 [42.8%] responders developed constipation according to Rome III criteria. With other words, the frequency of cow's milk allergy among constipated patients was 80%. Only one patient had positive skin prick test. In children, chronic constipation can be a manifestation of cow's milk allergy. At present, although several aspects must be further investigated, a therapeutic attempt with elimination diet is advisable in all children with constipation unresponsive to correct laxative treatment

Tacrolimus related hypertrophic cardiomyopathy in liver transplant recipients

Recently there are a number of reports on the cardiotoxicity of tacrolimus in post-transplant patients. There is no protocol for cardiovascular evaluation in these patients. This study was performed to evaluate the cardiotoxicity of tacrolimus in liver transplant recipients. We evaluated 63 post-liver transplant patients who received tacrolimus. They were evaluated for cardiovascular complications by physical examination, electrocardiographic and echocardiographic examinations within three and six months following liver transplantation. Serum tacrolimus levels were checked by ELISA. For comparison, we selected 50 post-liver transplant patients who received no tacrolimus and evaluated them for cardiovascular function identically. Among 63 patients, 42 were male [66.7%] and 21 were female [33.3%] 70% of the patients were adults, and 19 [30%] were within the pediatric age group. The cardiovascular examinations, electrocardiogram and echocardiography of all patients three months post-transplantation were normal except for two children who developed tacrolimus related cardiac complications. Both had high serum tacrolimus levels. No adults developed cardiovascular complications. In the control group, the results of the cardiovascular evaluations were normal in all cases. The cardiovascular toxicity of tacrolimus, such as hypertrophic cardiomyopathy, may be observed in pediatric patients. Therefore, we recommend routine regular cardiovascular evaluation of children after liver transplantation