Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series

Table 1 Demography, Cardiology workup Pre-Transplant, Clinical course and outcome

(S No.) Demography, age, gender, etiology MELD score	Cardiology workup EKG, QTc, CI, echocardiography EF, DSE	Clinical course: Intraop, post op	CPKMB % of Ck on diagnosis of HF (normal 3%-5%)[25]	Possible underlying cause of heart failure in decreasing order of possibility	Outcome
(1) 38 yr, male, cryptogenic, MELD 16	QTc < 445 ms CI: Present EF: 65% DSE: Inconclusive	Uneventful LDLT; Extubated POD 1; Pul. Edema POD 2; EF: 25%	16.80%	CiCd ABS CAD ALC	EF recovered to 40% on POD 4; EF: 55% on discharge at POD 25; Survived to discharge;
(2) 53 yr, male, ethanol MELD 35	QTc: 519 ms CI: Absent EF: 65% DSE: Negative for inducible ischemia	Uneventful LDLT; Portal vein thrombectomy; Terlipressin infusion preop and intraop; POD 1: EF: 25%; Gram negative sepsis with MOD	15.10%	ALC CiCd CAD ABS	EF recovered to 55% at POD 10; Died
(3) 55 yr, female, EHPVO with intraparenchymal extension, MELD 15	QTc: 532 ms CI: Absent EF: 65% DSE: Negative for inducible ischemia	Turbulent LDLT; Increasing inotrope and vasopressor requirement; EF: 20%; Severe vasoplegia	14.68%	ABS CiCd CAD ALC	EF never recovered; Vasoplegia did not respond; Died
(4) 26 yr female, ALF	QTc: 540 ms CI: Absent EF: 70% DSE: Not done	Uneventful LDLT; Re-exploration POD2 for bleed; SVT; EF: 25%;	14.84%	ABS CiCd CAD ALC	EF recovered to 50% at POD 4; Died
(5) 40 yr, male, ethanol MELD 21	QTc: 550 ms CI: Absent EF: 65% DSE: Negative for inducible ischemia	Uneventful DDLT POD1: EF: 30%	Not done	ALC CiCd ABS CAD	EF recovered to 40% at POD 4; Survived
(6) 38 yr, male, ethanol MELD 32	QTc: 550 ms CI: Absent EF: 65% DSE: Negative for inducible ischemia	Uneventful; POD 1: EF: 20%; Recurrent SVT	39.40%	ALC CiCd ABS CAD	EF never recovered; Died

CI: Chronotopic incompetence; EF: Ejection fraction; DSE: Dobutamine stress echocardiography; CiCd: Cirrhotic cardiomyopathy; HF: Heart failure; ABS: Acute broken heart syndrome; ALC: Alcoholic cardiomyopathy; MOD: Multi-organ dysfunction; QTc: Rate corrected QT interval on ECG.