Genetic, hematological, and immunological disorders transmissible with liver transplantation

Acquired Genotype-Positive Long QT Syndrome After Pediatric Heart Transplantation

BACKGROUND

Congenital long QT syndrome (LQTS) is rare but significant, as it carries a risk for ventricular arrhythmias and sudden cardiac death. Its diagnosis can be made clinically by serial ECGs, ambulatory ECG monitoring, and exercise stress testing; however, genetic testing is confirmatory in the majority of cases.

METHODS

Here, we describe a rare case of phenotype-positive LQTS in a 6-year-old heart transplant recipient, confirmed 5 years after transplantation to be genotype-positive and thus "acquired" from the transplanted heart.

RESULTS

Recognition of a persistently prolonged QTc interval on the recipient's serial ECGs led to ambulatory ECG monitoring and exercise stress testing-both of which were suspicious for LQTS. Ultimately, genetic evaluation and cardiac biopsy were obtained and resulted positive for a KCNQ1 pathogenic variant associated with Type 1 LQTS.

CONCLUSION

Recognition of persistent, otherwise unexplained, ECG abnormalities can prompt genetic analysis of the allograft, leading to the potential life-saving diagnosis of a channelopathy.

Metabolic iron disorder after liver transplant: Hereditary hemochromatosis in a pediatric recipient of a pediatric donor with unknown HFE C282Y homozygous mutation

We report a case of an iron overload syndrome twenty years after a liver transplantation in a patient without feature for secondary iron overload. The diagnosis of hemochromatosis with homozygous mutationC282Y in the graft was made possible with liver biopsy, using real-time PCR technique with Light-Cycler 480. Our case suggests that in case of iron overload syndrome after liver transplantation we can perform a liver biopsy with real-time PCR technique that allows us to search for the mutation of the HFE.

The rate of hepatic artery complications is higher in pediatric liver transplant recipients with metabolic liver diseases than with biliary atresia

BACKGROUND

Liver transplantation (LT) is an excellent treatment option for patients with biliary atresia (BA) who fail portoenterostomy surgery. LT is also increasingly performed in patients with metabolic liver diseases. This study compared the outcomes in pediatric patients who underwent LT for metabolic liver diseases and BA.

BASIC PROCEDURES

Data from 237 pediatric patients who underwent primary LT at Seoul National University Hospital from 1988 to 2015, including 33 with metabolic liver diseases and 135 with BA, were retrospectively analyzed.

MAIN FINDINGS

Compared with children with BA, children with metabolic liver diseases were significantly older at the time of LT (121.3 vs. 37.3 months; P < 0.001), and had lower Child-Pugh (7.1 vs. 8.4; P = 0.010) and Pediatric End-stage Liver Disease (6.5 vs. 12.8; P = 0.042) scores. Overall survival rates were similar (87.8% vs. 90.8%; P = 0.402), but hepatic artery (HA) complications were significantly more frequent in children with metabolic liver diseases (12.1% vs. 1.5%; P = 0.014).

PRINCIPAL CONCLUSION

Despite similar overall survival, children with metabolic liver diseases had a higher rate of HA complications.

TYPE OF SUBMISSION

Original article, Case control study, Retrospective.

EVIDENCE LEVEL

III.