Design: Retrospective cohort with echocardiographic, morphometric and histological comparison
Population: 226 children with cirrhosis and 160 without, listed for liver transplant, 2011–2021
Primary outcome: Waitlist decompensation, post-transplant serious adverse events and mortality
Effect: LV hypertrophy in about 25% (OR 6.9 vs controls); LVMI ≥95 g/m^2.7 independently associated with death

A single-programme cohort in the Journal of Hepatology, published on 12 October, compared echocardiography, heart morphology and histology in 226 children with cirrhosis and 160 without, all listed for liver transplant between 2011 and 2021.

Left ventricular mass was higher in cirrhosis, and about a quarter had left ventricular hypertrophy. Higher left ventricular mass index was independently associated with decompensation on the waiting list, serious complications after transplant and death, after adjusting for PELD/MELD, bilirubin and INR. Adding it to PELD/MELD improved prediction of decompensation and complications, though not of death.

Cirrhotic cardiomyopathy is recognised in adults but rarely sought in children. A routine echocardiogram already done for transplant listing can carry this information at no extra cost.

The thresholds came from one centre and need validation before they shape allocation decisions.

Report left ventricular mass index on pre-transplant echocardiograms in children with cirrhosis.
Treat raised left ventricular mass as a marker of higher perioperative risk.
Plan for higher vasoactive needs during transplant in children with ventricular hypertrophy.
Use alongside, not instead of, PELD or MELD scores.

Why it matters

It brings cirrhotic cardiomyopathy into paediatric risk assessment using a test already being done.

The statistics, in plain English

An odds ratio of 6.9 (95% CI 3 to 16) for hypertrophy in cirrhosis versus controls shows a strong link. The prognostic thresholds (88 to 95 g/m^2.7) were chosen from the same data they were tested on, which tends to overstate performance.