Liver cirrhosis in Fontan patients does not affect 1-year post-heart transplant mortality or markers of liver function

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• 作者：Kathleen E. Simpson ; Amir Esmaeeli ; Geetika Khanna ; Francis White ; Yumirle Turnmelle ; Pirooz Eghtesady ; Umar Boston ; Charles E. Canter
• 关键词：liver cirrhosis ; Fontan procedure ; heart transplant ; pediatric cardiology ; liver transplant
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：February, 2014
• 年：2014
• 卷：33
• 期：2
• 页码：170-177
• 全文大小：1263 K

文摘

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Background

Liver cirrhosis is recognized with long-term follow-up of patients after the Fontan procedure. The effect of liver cirrhosis on the use of heart transplant (HT) and on post-HT outcomes is unknown.

Methods

We reviewed Fontan patients evaluated for HT from 2004 to 2012 with hepatic computed tomography (CT) imaging, classified as normal, non-cirrhotic changes, or cirrhosis. The primary outcome was 1-year all-cause mortality, and the secondary outcome was differences in serial post-HT liver evaluation.

Results

CT imaging in 32 Fontan patients evaluated for HT revealed 20 (63%) with evidence of liver disease, including 13 (41%) with cirrhosis. Twenty underwent HT, including 5 non-cirrhotic and 7 cirrhosis patients. Characteristics at listing between normal or non-cirrhotic (n = 13) and cirrhosis (n = 7) groups were similar, except cirrhosis patients were older (median 17.6 vs 9.6 years, p = 0.002) and further from Fontan (median 180 vs 50 months, p < 0.05). Serial liver evaluation was similar, including aspartate aminotransferase, alanine aminotransferase, bilirubin, albumin, and tacrolimus dose at 1, 3, 6, 9, and 12 months. Overall patient survival was 80% at 1 year, with no difference between cirrhosis and non-cirrhosis patients (86% vs 77%, p = 0.681). Liver biopsies were performed in 7 patients before HT, and all specimens showed architectural changes with bridging fibrosis.

Conclusions

Most patients evaluated for HT had abnormal liver findings by CT, with cirrhosis in 41%. One-year mortality and serial liver evaluation were similar between groups after HT. Liver cirrhosis identified by CT imaging may not be an absolute contraindication to HT alone in this population.