Corrected QT interval and QT dispersion in cirrhotic patients before and after liver transplantation

Liver cirrhosis is associated with different types of electrophysiological changes, including QT prolongation, which may adversely affect long-term prognosis of these patients. The aim of this study is to evaluate the effect of orthotopic liver transplantation [LT] on corrected QT [QTc] interval and QT dispersion [QTd] in cirrhotic patients of various etiologies. We enrolled 249 patients with end-stage liver disease between 2004 and 2009 at Shiraz Transplant Research Center, Shiraz, Iran. The QTc interval and QTd were measured by 12 lead ECGs for baseline and at 3 months after LT. Mean QTc interval and mean QTd were calculated. A QTc interval above 440 ms was considered abnormal. Within 3 months following surgery, 6 patients died. There were 105 patients [43.2%] with prolonged QTc before transplantation; in 91 [86.6%] patients, the mean QTc normalized after transplantation [baseline: 490.9 +/- 45.74 ms; post-transplantation: 385 +/- 48.74 ms; P < 0.0001]. Fourteen patients [13.3%] had evidence of some shortening of the QTc interval although the QTc remained above the upper limit of normal. Prolongation of the QTc interval in cirrhotic patients was independent of the etiology of cirrhosis. A normal QTc was seen in 138 patients [56.7%] before transplantation, of which 4 [2.9%] developed prolonged QTc after transplantation. The mean QTd decreased significantly after transplantation [baseline: 30 +/- 20 ms; post-transplantation: 30 +/- 10 ms; P < 0.0001]. Many cirrhotic patients have prolonged QTc intervals before LT regardless of disease etiology. In the majority of patients this value returns to normal after LT, suggesting that liver cirrhosis has independent unfavorable, but reversible electrophysiological effects

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