Introduction: We describe 3 cases of non-ischemic cardiomyopathy (NICM) following liver transplantation (LT) in patients with pre-transplant sarcopenia.

Reports: All 3 patients were transplanted at a single center. The patients were noted to have pre-transplant sarcopenia, as determined by their mean total psoas area (TPA) at L4 on CT or MRI pre-transplant imaging.

Patient 1 is a 62-year-old male (MELD 13, body mass index (BMI) 19.8) diagnosed with hepatocellular carcinoma (HCC) in the setting of hepatitis C (HCV) cirrhosis who had a normal preoperative transthoracic echocardiogram (TTE) with a left ventricular function ejection fraction (LVEF) of 60% and a normal dobutamine stress echocardiogram (DSE). Four months after LT, repeat TTE was performed which showed decreased EF of 31% with mild to moderate global LV dysfunction. Diagnostic left heart catheterization showed non-significant 60% stenosis of the 2nd diagonal coronary artery. Patient expired 11 months post LT.

Patient 2 is a 61-year-old male (MELD 23, BMI 20.5) diagnosed with HCC in the setting of HCV cirrhosis who had a pre LT TTE with an LVEF of 60% and normal DSE. Repeat TTE performed two months after LT demonstrated EF of 10% with severe global LV dysfunction. Normal LV function has not returned at 5-months post LT.

Patient 3 is a 60-year-old male (MELD 29, BMI 18.9) diagnosed with HCV cirrhosis who had pre LT TTE with a normal LVEF of 75% and normal DSE. TTE performed three months after LT showed EF of 35% with moderate global LV dysfunction. Diagnostic left heart catheterization showed minor luminal irregularities. Patient expired 7 months post LT.

Discussion: Few previous retrospective studies have evaluated clinical predictors of new-onset heart failure post-LT. Although NICM is thought to be a rare complication, critically ill, high MELD patients, particularly those with severe malnutrition, may be at highest risk. Sarcopenia, as seen in all 3 of our patients, is an indicator of nutritional status and should be studied further as a possible predictor for the development of NICM post LT. Pre-operative optimization of nutritional status, in addition to, close post-LT TTE monitoring is advised in this population at risk for adverse cardiovascular outcomes post-LT.

« Back to 2015 American Transplant Congress