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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Hepatic dysfunction and survival after orthotopic heart transplantation: Application of the MELD scoring system for outcome prediction

      Background

      The prevalence of heart failure (HF) is rising and the only corrective treatment is cardiac transplantation. Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. We hypothesized that hepatic dysfunction is associated with impaired clinical outcome after heart transplantation.

      Methods

      Data of 617 adult patients (75% men, mean age 53 ± 12 years, mean BMI 25 ± 4, mean ejection fraction 19 ± 9%) undergoing orthotopic heart transplantation (OHT) were analyzed retrospectively. Deviation from institutional normal ranges was used to define abnormal liver function. Standard Model for End-stage Liver Disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) was created to eliminate the confounding effects of anti-coagulation.

      Results

      Before OHT, AST, ALT and total bilirubin were elevated in 20%, 18% and 29% of the population, respectively. Total protein and albumin were decreased in 25% and 52% of the population, respectively. By 2 months post-transplantation, percentages of individuals with pathologic values decreased significantly, except for ALT, total protein and albumin, all of which took longer to normalize. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up.

      Conclusions

      In this large, single-center retrospective study, we demonstrated the dynamics of liver dysfunction after cardiac transplantation and that elevated MELD scores indicating impaired liver function are associated with poor clinical outcome after OHT. Thus, pre-operative liver dysfunction has a significant impact on survival of patients after cardiac transplantation.

      Keywords

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      References

        • Neubauer S.
        The failing heart—an engine out of fuel.
        N Engl J Med. 2007; 356: 1140-1151
        • van Deursen V.M.
        • Damman K.
        • Hillege H.L.
        • et al.
        Abnormal liver function in relation to hemodynamic profile in heart failure patients.
        J Card Fail. 2010; 16: 84-90
        • Kamath P.S.
        • Wiesner R.H.
        • Malinchoc M.
        • et al.
        A model to predict survival in patients with end-stage liver disease.
        Hepatology. 2001; 33: 464-470
        • Wiesner R.
        • Edwards E.
        • Freeman R.
        • et al.
        • United Network for Organ Sharing Liver Disease Severity Score Committee
        Model for end-stage liver disease (MELD) and allocation of donor livers.
        Gastroenterology. 2003; 124: 91-96
        • Uriel N.
        • Vainrib A.
        • Jorde U.P.
        • et al.
        Mediastinal radiation and adverse outcomes after heart transplantation.
        J Heart Lung Transplant. 2010; 29: 378-381
        • Naschitz J.E.
        • Slobodin G.
        • Lewis R.J.
        • et al.
        Heart diseases affecting the liver and liver diseases affecting the heart.
        Am Heart J. 2000; 140: 111-120
        • Cogger V.C.
        • Fraser R.
        • Le Couteur D.G.
        Liver dysfunction and heart failure.
        Am J Cardiol. 2003; 91: 1399
        • Dichtl W.
        • Vogel W.
        • Dunst K.M.
        • et al.
        Cardiac hepatopathy before and after heart transplantation.
        Transpl Int. 2005; 18: 697-702
        • Allen L.A.
        • Felker G.M.
        • Pocock S.
        • et al.
        • CHARM Investigators
        Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program.
        Eur J Heart Fail. 2009; 11: 170-177
        • Lau G.T.
        • Tan H.C.
        • Kritharides L.
        Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation.
        Am J Cardiol. 2002; 90: 1405-1409
        • Kubo S.H.
        • Walter B.A.
        • John D.H.
        • et al.
        Liver function abnormalities in chronic heart failure.
        Arch Intern Med. 1987; 147: 1227-1230
        • Shinagawa H.
        • Inomata T.
        • Koitabashi T.
        • et al.
        Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure.
        Circ J. 2008; 72: 364-369
        • Nishi H.
        • Takahashi T.
        • Ichikawa H.
        • et al.
        Prediction of postoperative hepatic dysfunction after cardiac surgery in patients with chronic congestive heart failure.
        Gen Thorac Cardiovasc Surg. 2009; 57: 357-362
        • Northup P.G.
        • Wanamaker R.C.
        • Lee V.D.
        • et al.
        Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis.
        Ann Surg. 2005; 242: 244-251
        • Ailawadi G.
        • Lapar D.J.
        • Swenson B.R.
        • et al.
        Model for end-stage liver disease predicts mortality for tricuspid valve surgery.
        Ann Thorac Surg. 2009; 87: 1460-1467
        • Suman A.
        • Barnes D.S.
        • Zein N.N.
        • et al.
        Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores.
        Clin Gastroenterol Hepatol. 2004; 2: 719-723
        • Hsu R.B.
        • Chang C.I.
        • Lin F.Y.
        • et al.
        Heart transplantation in patients with liver cirrhosis.
        Eur J Cardiothorac Surg. 2008; 34: 307-312
        • Ziser A.
        • Plevak D.J.
        Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery.
        Curr Opin Anaesthesiol. 2001; 14: 707-711
        • Hayashida N.
        • Aoyagi S.
        Cardiac operations in cirrhotic patients.
        Ann Thorac Cardiovasc Surg. 2004; 10: 140-147
        • Vasconcelos L.A.
        • de Almeida E.A.
        • Bachur L.F.
        Clinical evaluation and hepatic laboratory assessment in individuals with congestive heart failure.
        Arq Bras Cardiol. 2007; 88: 590-595