Background: Myocardial performance index (MPI) or Tei index is a Doppler-derived index of combined systolic and diastolic myocardial function, calculated as the sum of is volumetric relaxation time (IRT) and isovolumetric contraction time (ICT) divided by the ejection time (ET).Objective: To evaluate the right and left ventricular systolic and diastolic function using MPI in children before and after liver transplantation.Methods: A cross-sectional study was conducted on 30 children with liver cirrhosis before liver transplantation, 30 age-matched comparison group at least 6 months after liver transplantation, and 30 aged-matched children without history of heart disease in Nemazi Liver Transplant Center, Shiraz, Iran, from April 2012 to April 2014. Echocardiographic evaluation was carried out with a GE Vivid 3 echocardiographic machine, using a 3-MHz probe with tissue Doppler imaging (TDI) software using conventional and TDI method.Results: The mean±SD left ventricle Tei index in patients was 0.33±0.02 before liver transplantation, 0.34±0.02 after liver transplantation, and 0.33±003 in the comparison group (p=0.36). The mean±SD right ventricular Tei index was 0.35±0.04 in patients before transplantation, 0.36±0.46 after liver transplantation, and 0.28±0.04 in the comparison group (p<0.001). In addition, when TDI was used, the mean±SD left ventricular Tei index was 0.39±0.50 in patients before transplantation, 0.37±0.42 after liver transplantation, and 0.38±006 in the comparison group (p=0.32). The tissue Doppler-derived Tei index for the right ventricle was 0.37±0.04 in patients before transplantation, 0.37±0.04 after liver transplantation, and 0.33±0.05 in the comparison group (p=0.031). The left ventricular Doppler-derived Tei index had a significant (p=0.03) correlation with Child-Turcotte-Pugh (CTP) score (r=0.57).Conclusion: Left ventricular MPI with Doppler echocardiography was correlated with CTP score. Right ventricular MPI was significantly increased in patients with cirrhosis and did not improve 6 months after transplantation.

Background: Although patient and graft survival rates have been increased, biliary complications after liver transplantation are associated with significant morbidity and mortality. There is a multidisciplinary approach to solve this problem.Objective: We reviewed our experience in management of biliary complications after deceased donor liver transplantation in 105 patients over a 13-year period.Methods: We reviewed records of 105 patients who underwent deceased donor liver transplantation at Nemazee Hospital, Shiraz, southern Iran, who presented with clinical or biochemical signs of biliary complications between January 2000 and September 2013. All patients presented with abnormal results on liver function tests and a variety of clinical symptoms such as fever, icter, and cholangitis. In addition, if the find ings of a liver biopsy were not conclusive for rejection or for recurrent HCV infection, sonography or MRCP was performed to rule out any biliary complications. If we suspected to any biliary problems, ERCP or PTC was performed for the patients. If the complication was not resolved by the above-mentioned procedures, exploration of common bile duct and Roux-en-Y choledochojejunostomy was done for the patients.Results: Our study group comprised 105 patients; 64 (61%) men and 41 (39%) women with a mean±SD age of 33.6±14.8 (range: 3–66) years. The interval between orthotopic liver transplantation and the clinical onset of biliary complications ranged from 1 to 122 (mean±SD of 18.8±28.2) months. The most common indications for liver transplantation were cryptogenic cirrhosis (n=29), HBV-induced liver cirrhosis (n=15), primary sclerosing cholangitis (n=13), autoimmune hepatitis (n=13), and Wilson’s disease (n=11). The biliary tract was reconstructed with choledochocholedochostomy (duct to duct anastomosis) in 87 (87%) and Roux-en-Y choledochojejunostomy in 13 (13%) liver transplantations. ERCP and PTC were performed in 73 (69.5%), and 25 (23.8%) suspected patients with biliary complications, respectively. Secondary operation and biliary exploration was performed in 39 (37.1%) patients.21 (28%) of patients who underwent ERCP, and 12 (48%0 of those who underwent PTC needed biliary exploration.Conclusion: ERCP and PTC are effective management for biliary complications after liver transplantation.