Background
Liver dysfunction increases post-surgical morbidity and mortality. The Model of End-stage
Liver Disease (MELD) estimates liver function but can be inaccurate in patients receiving
oral anti-coagulation. We evaluated the effect of liver dysfunction on outcomes after
ventricular assist device (VAD) implantation and the dynamic changes in liver dysfunction
that occur during VAD support.
Methods
We retrospectively analyzed 255 patients (147 with pulsatile devices and 108 with
continuous-flow devices) who received a long-term VAD between 2000 and 2010. Liver
dysfunction was estimated by MELD and MELD-eXcluding INR (MELD-XI), with patients
grouped by a score of ≥ 17 or < 17. Primary outcomes were on-VAD, after transplant,
and overall survival.
Results
MELD and MELD-XI correlated highly (R ≥ 0.901, p < 0.0001) in patients not on oral anti-coagulation. Patients with MELD or MELD-XI
< 17 had improved on-VAD and overall survival (p < 0.05) with a higher predictive power for MELD-XI. During VAD support, cholestasis
initially worsened but eventually improved. Patients with pre-VAD liver dysfunction
who survived to transplant had lower post-transplant survival (p = 0.0193). However, if MELD-XI normalized during VAD support, post-transplant survival
improved and was similar to that of patients with low MELD-XI scores.
Conclusions
MELD-XI is a viable alternative for assessing liver dysfunction in heart failure patients
on oral anti-coagulation. Liver dysfunction is associated with worse survival. However,
if MELD-XI improves during VAD support, post-transplant survival is similar to those
without prior liver dysfunction, suggesting an important prognostic role. We also
found evidence of a transient cholestatic state after LVAD implantation that deserves
further examination.
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.
