Temporary cardiac pacing for fatal arrhythmia in living-donor liver transplantation: three case reports

Arrhythmia risk in liver cirrhosis

Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances, impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT interval-prolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.

A malignant hyperthermialike episode in a liver transplant recipient

We report a case of malignant hyperthermialike syndrome in a living-donor liver transplant recipient with no familial history of malignant hyperthermia or exposure to known triggering drugs. The patient showed many features of a typical malignant hyperthermia episode, and The Clinical Grading Scale defined this case as almost certain to be an episode of malignant hyperthermia (rank 5). However, the diagnosis was questionable. The intraoperative and perioperative periods during liver transplant can involve drastic alterations of physiological parameters, which can make malignant hyperthermia difficult to diagnosis. The data we obtained using a pulmonary artery catheter suggest an intraoperative increase in systemic oxygen consumption.