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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Article info
Publication history
Published online: March 29, 2012
Identification
Copyright
© 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
