Effects of orthotopic liver transplantation on the corrected QT interval in patients with end-stage liver disease

Autonomic dysfunction is a recognized complication of end-stage liver disease (ESLD) associated with a poor prognosis. The corrected QT interval (QTc) on electrocardiogram is a marker of autonomic function. A few small studies have suggested that QTc may normalize with the return of liver function after orthotopic liver transplantation. We sought to determine how transplantation affects the QTc in patients with ESLD. The QTc from the pretransplantation evaluation of 46 patients with ESLD was compared with the QTc at 4-month posttransplantation follow-up. Other factors that can influence autonomic function also were evaluated. Most patients with ESLD (54%) showed a prolonged QTc (greater than or equal to 440 msec) at the pretransplantation evaluation ( 451 +/- 45 msec) that improved to within the normal range at posttransplantation follow-up ( 418 +/- 18 msec; P < 0.001). There was no relationship between QTc prolongation and Child - Turcotte - Pugh score, Model for End-Stage Liver Disease score, diabetes mellitus, age, or etiology of liver disease. Most patients with ESLD and a prolonged QTc will have a significant improvement in QTc after transplantation; however, 6.5% of patients in our study had a worsening of QTc after transplantation.