This study was carried out to compare echocardiographic findings of children taking tacrolimus and cyclosporin A (CsA) after orthotopic liver transplantation (OLT). Echocardiograms of 19 children were reviewed during hospitalizations after OLT, and echocardiograms were performed on 23 children who returned to the clinic for a routine follow-up visit after OLT. Measurements were made of the left ventricle (LV) end-diastolic dimension, and of the thickness of the LV free wall (LVFW) and the inter-ventricular septum (IVS). From these measurements, the LV mass was calculated. LV outflow gradient was measured by using Doppler interrogation. Comparisons were made between patients on CsA and patients on tacrolimus. Children with hypertrophic cardiomyopathy (HCM) were identified. Two patients from the in-patient tacrolimus group were found to have HCM. These two patients had asymmetric septal hypertrophy with dynamic LV outflow obstruction and were successfully treated with propranolol, with or without discontinuing tacrolimus. In the out-patient studies, there was no difference in LVFW and IVS thickness, or LV mass index, between children on CsA and children on tacrolimus. Hence, tacrolimus is associated with the development of HCM in children. The effect of tacrolimus on HCM development may be acute and temporary. More data are needed to determine the incidence of HCM in children on tacrolimus therapy and to establish guidelines for clinicians who follow-up these children.

译文

:本研究旨在比较原位肝移植(OLT)后服用他克莫司和环孢菌素A(CsA)的儿童的超声心动图结果。在OLT住院期间对19例儿童的超声心动图进行了回顾,对23例在OLT后返回诊所进行常规随访的儿童进行了超声心动图检查。测量左心室(LV)舒张末期的尺寸,左心室游离壁(LVFW)和心室间隔(IVS)的厚度。通过这些测量,计算出LV质量。左室流出梯度通过多普勒询问来测量。比较接受CsA的患者和接受他克莫司治疗的患者。确定患有肥厚型心肌病(HCM)的儿童。住院他克莫司组的两名患者被发现患有HCM。这两名患者出现不对称的间隔肥厚,并伴有动态左室流出道梗阻,并成功接受普萘洛尔治疗,无论是否停用他克莫司。在门诊研究中,CsA组儿童和他克莫司组儿童的LVFW和IVS厚度或LV质量指数没有差异。因此,他克莫司与儿童HCM的发展有关。他克莫司对HCM发展的影响可能是急性的和暂时的。需要更多数据来确定他克莫司治疗儿童的HCM发生率,并为随访这些儿童的临床医生建立指导方针。

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