■可行性数据,管理,和肝移植的结果(LT)的患者预先存在左心室收缩功能障碍(LVSD),严重冠状动脉疾病(CAD)或肝硬化心肌病(CCM)很少见。
■我们回顾了2010年7月至2018年7月进行的1946年LDLT系列中LVSD(射血分数[EF]<50%)受者活体肝移植(LDLT)的结果。
■在12名平均年龄的男性患者中检测到LVSD,BMI和MELD为52±9岁,25±5kg/m2,19±4。在这些中,6例患者有CAD(2例既往有冠状动脉旁路移植术,1在最近的经皮冠状动脉腔内成形术后,2心肌梗死后,1个非关键CAD),和6有CCM。EF范围从25%到45%。乙醇是肝硬化的主要潜在病因(50%)。在LDLT期间,2例患者出现了室性异位心律,并通过静脉注射利多卡因成功治疗。应激性心肌病表现为3例患者术后EF降低,其中2个改进,而1个需要IABP支持并在术后第8天(POD)死于多器官衰竭。另一名患者因感染性休克而死于POD30。这些患者都有较高的MELD评分(实际MELD),极端的BMI(17.3和35.8kg/m2)和糖尿病。没有长期的心脏死亡。1年,5年生存率为75%,66%,分别。
■在潜在的LVSD患者中,那些具有稳定的CAD和良好的性能状态,经过精心优化的CCM患者在有经验的中心进行仔细的风险分层后,可考虑进行LDLT治疗.
UNASSIGNED: Data on feasibility, management, and outcomes of liver transplantation (LT) in patients with pre-existing left ventricular systolic dysfunction (LVSD), severe coronary artery disease (CAD) or cirrhotic cardiomyopathy (CCM) is scarce.
UNASSIGNED: We reviewed outcomes of living donor liver transplantation (LDLT) in recipients with LVSD (ejection fraction [EF] < 50%) from our series of 1946 LDLT\'s performed between July 2010 and July 2018.
UNASSIGNED: LVSD was detected in 12 male patients with a mean age, BMI and MELD of 52 ± 9 years, 25 ± 5 kg/m2, and 19 ± 4 respectively. Out of these, 6 patients had CAD (2 with previous coronary artery bypass graft, 1 following recent percutaneous transluminal coronary angioplasty, 2 post myocardial infarction, 1 noncritical CAD), and 6 had CCM. The EF ranged from 25% to 45%. Ethanol was the predominant underlying etiology for cirrhosis (50%). During LDLT, 2 patients developed ventricular ectopic rhythm and were managed successfully with intravenous lidocaine. Stress cardiomyopathy manifested in 3 patients post operatively with decreased EF, of which 2 improved, while 1 needed IABP support and succumbed to multiorgan failure on 8th postoperative day (POD). Another patient died on POD30 due to septic shock. Both these patients had higher MELD scores (actual MELD), extremes of BMI (17.3and 35.8 kg/m2) and were diabetic. There were no long-term cardiac deaths. The 1-year, and 5-year survival were 75%, and 66%, respectively.
UNASSIGNED: Among potential LT recipients with LVSD, those with stable CAD and good performance status, and well optimized CCM patients may be considered for LDLT after careful risk stratification in experienced centers.