Background Surgical stress, liberation of cytokines associated with re-perfusion injury, and long standing use of immunosuppressive medications in children recipients of orthotopic living related liver transplantation (OLRLT) pose cardiovascular risk. Cardiovascular adverse effects vary from left ventricular wall thickening, hypertrophic cardiomyopathy to resting ECG abnormalities, asymptomatic ST depression following increased heart rate and ventricular arrhythmias.

Aim of work To assess cardiovascular structural and functional changes in children recipients of OLRLT.

Methods We assessed cardiac structure and function in 25 children recipients of orthotopic living related liver transplantation by conventional 2-D, M- mode echocardiography and Doppler.

Results Mean age +/- SD at transplantation and at enrollment in study were 6.3+/ 4.5yrs and 13.5 +/- 5.6 yrs respectively. All children were on tacrolimus, as a single immunosuppressive medicine in only 3, and in association with steroids, azathioprine or mycofenolate mofitel as a double therapy (12 children), triple therapy (10 children). Echocardiography showed significant interventricular septal hypertrophy (mean thickness 0.89) in 21, 24 had pulmonary hypertension (mean mPAP +/-36.4), and early diastolic dysfunction Tei index (mean +/- 0.40). However Cardiac function was generally preserved. A child developed severe aortic stenosis that necessitated catheter dilatation and was reversed over 12 months after discontinuation of tacrolimus. Discontinuation of tacrolimus reversed pulmonary hypertension, diastolic dysfunction and hypertrophy of left ventricle and/or interventricular hypertrophy.

Conclusion Asymptomatic cardiac adverse effects are common following OLRLT. We encountered pulmonary hypertension, increased cardiac mass, aortic stenosis and diastolic heart failure among our studied population. Findings are reversed within 12 months of discontinuation of tacrolimus.