Cardiac evaluation in pediatric patients waiting for liver transplantation

Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT). The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7%) heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5%) had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1%) patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18%) patients. Eleven patients (12.4%) had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6%) patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.