Prevalence and correlates of gastroesophageal reflux disease in Southern Iran: pars cohort study

Background: Prevalence of gastroesophageal reflux disease [GERD] is increasing worldwide. We aimed to estimate the prevalence of GERD in Pars Cohort Study [PCS] and to find its correlates

Methods: We used the baseline data from PCS. PCS was conducted in the district of Valashahr in Fars province in southern Iran from 2012 to 2014. 9264 inhabitants who were 40-75 years old, and agreed to participate were enrolled. Data were collected by a structured questionnaire and simple physical examination of all participants

Results: Generally, 58.50% [95% CI 57.49 - 59.51] of the participants had GERD and 25.10% [95% CI 24.22 - 25.99] experienced it at least weekly. Approximately, 32.0%, 52.0%, and 24.4% of the participants reported heart burn sensation, regurgitation, and both symptoms, respectively. Being female [OR: 1.45, 95% CI 1.27 - 1.65], being older [OR: 1.20, 95% CI 1.06 - 1.36], being divorced/ widowed/separated [OR: 1.38, 95% CI 1.01 - 1.91], and lower education [OR: 1.43, 95% CI 1.02 - 2.03] were associated with frequent GERD

Conclusion: GERD is common in PCS and its prevalence is close to that in western countries. Being female, higher age, being divorced/widowed/separated, lower education, history of hypertension, anxiety, insomnia, and non-cigarette tobacco smoking were associated with frequent GERD. We are going to investigate the causal relationship between these risk factors and GERD in the next stages of PCS

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

Chiropractic: is it efficient in treatment of diseases? review of systematic reviews

Chiropractic is a complementary medicine that has been growing increasingly in different countries over recent decades. It addresses the prevention, diagnosis and treatment of the neuromusculoskeletal system disorders and their effects on the whole body health. This study aims to evaluate the effectiveness of chiropractic in the treatment of different diseases. To gather data, scientific electronic databases, such as Cochrane, Medline, Google Scholar, and Scirus were searched and all systematic reviews in the field of chiropractic were obtained. Reviews were included if they were specifically concerned with the effectiveness of chiropractic treatment, included evidence from at least one clinical trial, included randomized studies and focused on a specific disease. The research data including the article's first author's name, type of disease, intervention type, number and types of research used, meta-analysis, number of participants, and overall results of the study, were extracted, studied and analyzed. Totally, 23 chiropractic systematic reviews were found, and 11 articles met the defined criteria. The results showed the influence of chiropractic on improvement of neck pain, shoulder and neck trigger points, and sport injuries. In the cases of asthma, infant colic, autism spectrum disorder, gastrointestinal problems, fibromyalgia, back pain and carpal tunnel syndrome, there was no conclusive scientific evidence. There is heterogeneity in some of the studies and also limited number of clinical trials in the assessed systematic reviews. Thus, conducting comprehensive studies based on more reliable study designs are highly 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

Designing and conducting MD/MPH dual degree program in the Medical School of Shiraz University of Medical Sciences

Introduction: Many studies have focused on the need of health systems to educated physicians in the clinical prevention, research methodology, epidemiology and health care management and emphasize the important role of this training in the public health promotion. On this basis, Shiraz University of Medical Sciences [SUMS] has established MD/MPH dual degree program since the year 2012

Methods: In the current study, Delphi technique was used. Both qualitative and quantitative methods were applied in the Delphi process. The Delphi team members including experts with extensive experience in teaching, research and administration in the field of educational management and health/medical education reached consensus in almost 86% of the questionnaire items through three Delphi rounds. MD/MPH program for SUMS was designed based on the items agreed and thematic analysis used in these rounds

Results: The goals, values, mission and program requirements including the period, the entrance condition, and the number of units, and certification were determined. Accordingly, the courses of the program are presented in parallel with the MD education period. MPH courses consist of 35 units including 16 obligatory and 15 voluntary ones

Conclusion: Designing MD/MPH program in SUMS based on the existent models in the universities in different countries, compatible with educational program of this university and needs of national health system in Iran, can be a beneficial measure towards promoting the students' knowledge and theoretical/practical skills in both individual and social level. Performing some additional research to assess the MD/MPH program and some cohort studies to evaluate the effect of this program on the students' future professional life is recommended

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

Diffuse hepatic calcifications in a transfusion- dependent patient with beta-thalassemia: a case report

Hepatic calcification is usually associated with infectious, vascular, or neoplastic processes in the liver. We report the first case of beta-thalassemia major with isolated diffuse hepatic calcification in a 23 year old woman, who had been transfusiondependent since the age of 6 months. She was referred to our center with a chief complaint of abdominal pain. Computed tomography scan of the abdomen revealed diffuse hepatic calcification in the right, left, and caudate lobes of the liver. Her medical history disclosed hypoparathyroidism as well as chronic hepatitis C virus infection, which was successfully treated but led to early micronodular cirrhosis on liver biopsy. Other studies done to search for the cause of hepatic calcification failed to reveal any abnormalities. We suspect that hypoparathyroidism caused liver calcification, and should be, therefore, considered in the differential diagnosis of hepatic calcification if other causative factors have been ruled out

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

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 portal hypertension in children: a single center's experiences

All conditions that interfere with blood flow at any level within the portal system can lead to portal hypertension. For better management of this disorder, it is important to determine the underlying cause. In previous studies, extra-hepatic disorders have been reported as the main cause of portal hypertension in children. In this study, we investigate the underlying causes of portal hypertension in children. This prospective, descriptive study investigated the etiology of 45 children with portal hypertension who referred to Nemazee Hospital Pediatric Gastroenterology Ward from 2005 to 2007. The underlying causes of portal hypertension were determined by liver biopsy, abdominal sonography, abdominal computed tomography scan, and liver Doppler sonography. In this study, 42 of 45 patients [93.3%] developed portal hypertension due to intrahepatic diseases. Extra-hepatic portal hypertension was detected in 3 [6.7%] patients with portal vein thrombosis. Intrahepatic diseases were the most common etiology of portal hypertension among children who referred to our center.

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.

Evaluation of quality of life in children six months after liver transplantation

Liver transplantation [LT] is now performed as a cure for numerous untreatable pediatric liver diseases. Quality of life [QoL] can be affected in pediatric patients with LT. Many factors are responsible for lower scores of QoL. This article aims to detail QoL in liver recipients six months following LT in children.We assessed QoLwith the following questionnaires: Child Health Quality-Parent Form 50 [CHQ-PF 50] for parents and Child Health Quality-Child Form 87 [CHQ-CF 87] for children >/= 10 years of age in 50 children with LT and their parents. According to the CHQ-PF 50 questionnaire, QoL was found to be significantly lower in LT children compared with healthy children. According to the CHQ-CF 87 questionnaire, QoL was similar in pediatric liver recipients and the normal population. According to parents' judgments, childhood liver recipients have impaired QoL. This may be due to multiple factors that include concern about the long term outcome of LT, comparing their child with other children, and complications of LT. On the other hand, older children and adolescents believe their QoL is similar to healthy children. It seems that by decreasing risk factors, we can reduce stress on families and improve QoL

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