Takotsubo Syndrome in Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Published Studies and Case Reports

Abstract

Orthotopic liver transplantation (OLT) is a major surgical procedure that presents significant physical stress to recipients. Despite the extensive pre-transplant cardiac workup, cardiovascular (CV) complications are significant, and they impact the short-term and longterm outcomes. A meta-analysis on overall CV outcomes in OLT patients reported a 22.6% average incidence of CV events within 6 months and 11.8% after six months post-transplant.

A few cases of Takotsubo Syndrome (TTS) in OLT recipients have been reported in the literature, however, pooled data on the incidence, risk factors, mortality, and prognosis remain underreported. TTS, First discovered in 1991 in Japan, is a cardiac syndrome characterized as an acute and transient regional left ventricular (LV) systolic dysfunction in the absence of obstructive coronary artery disease (CAD)2. Electrical changes are also seen on the electrocardiogram (EKG) which may notably mimic myocardial infarction, however, there is a minimal release of myocardial enzymes3. Despite the dramatic presentation with a significant drop in the left ventricular ejection fraction (LVEF), there is usually a full recovery, however, thenunderstanding of etiological mechanism is still evolving. It is thought to be stress-induced, reversible cardiomyopathy related to periods of great physical or psychological burden. This systematic review aims to gain more information regarding such clinical correlations (TTS in OLT), appropriate investigation and management to better serve this group of patients. This analysis also aims to gain an understanding of the morbidity and mortality of TTS in OLTpatients and the impact on the post-operative course as well as possible emerging clinical predictors.

Note:

Funding Information: None.

Declaration of Interests: None.

Keywords: Liver transplantation, orthotopic liver transplantation, takotsubo syndrome, takotsubo cardiomyopathy, systematic review, meta-analysis