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Sarcopenia and Non-Ischemic Cardiomyopathy After Liver Transplantation

A. Mathew,1 J. Pan,1 F. Guglielmo,2 A. Shah,3 C. Doria,3 D. Sass,1 D. Halegoua-De Marzio.1

1Medicine, Division of Gastroenterolgy and Hepatology, Thomas Jefferson University, Philadelphia, PA
2Radiology, Thomas Jefferson University, Philadelphia, PA
3Surgery, Division of Transplantation, Thomas Jefferson University, Philadelphia, PA.

Meeting: 2015 American Transplant Congress

Abstract number: C134

Keywords: Echocardiography, Heart failure, Outcome, Weight

Session Information

Session Name: Poster Session C: Liver Retransplantation and Other Complications

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

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.

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To cite this abstract in AMA style:

Mathew A, Pan J, Guglielmo F, Shah A, Doria C, Sass D, Marzio DHalegoua-De. Sarcopenia and Non-Ischemic Cardiomyopathy After Liver Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/sarcopenia-and-non-ischemic-cardiomyopathy-after-liver-transplantation/. Accessed May 20, 2025.

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