Long-term effect of liver transplantation on cirrhotic autonomic cardiac dysfunction

There is little information on the long-term effect of liver transplantation (LT) on cardiac autonomic dysfunction in cirrhotic patients. We compared cardiac autonomic function before and in the long-term after LT. in a transversal study, we investigated 30 cirrhotics awaiting LT, 15 clinically stable patients 2-6 years after LT and 27 healthy controls. Seven cirrhotic patients were studied before LT, and 6, 12 and 33 months after LT, in a prospective fashion. Cardiac autonomic function was measured by heart rate variability (HRV) analysis during 24-h electrocardiogram recording. In the transversal Study, patients with cirrhosis as compared to healthy controls had Significantly reduced standard deviation of normal-to-normal RR intervals (SDNN) (p < 0.001) and of the square root of the mean of squared differences between adjacent NN intervals (RMS-SD) (p < 0.01), while the ratio between low frequency (LF) and high frequency (HF) at night was significantly (p < 0.05) increased. Liver transplanted patients had significantly (p < 0.001) higher SDNN Values than cirrhotics, while RMS-SD and LF/HF at night did not differ. In the prospective Study, SDNN progressively increased after LT and was significantly (p < 0.05) higher at 12 and 33 months, compared to the pre-operative value. RMS-SD and LF/HF at night did not change after LT. In conclusion, the overall HRV decrease present in cirrhosis, measured by SDNN Values, is partially corrected in the long-term after LT. However, parasympathetic impairment, measured by RMS-SD and LF/HF at night, is not affected even in the long-term after operation. (C) 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.