Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction

Maryjane Farr, James Mitchell, Matthew Lippel, Tomoko S. Kato, Zhezhen Jin, Paul Ippolito, Lorna Dove, Ulrich P. Jorde, Hiroo Takayama, Jean Emond, Yoshifumi Naka, Donna Mancini, Jay H. Lefkowitch, P. Christian Schulze

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. Methods Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. Results Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived 1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score 45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). Conclusions Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction.

Original languageEnglish (US)
Pages (from-to)873-882
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Fingerprint

End Stage Liver Disease
International Normalized Ratio
Liver Diseases
Heart Failure
Transplants
Biopsy
Liver
Fibrosis
Waiting Lists
Heart Transplantation
Proportional Hazards Models
ROC Curve
Uncertainty
Ventilation
Survivors
Transplantation

Keywords

  • congestive hepatopathy
  • fibrosis
  • heart failure
  • liver disease
  • risk stratification

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction. / Farr, Maryjane; Mitchell, James; Lippel, Matthew; Kato, Tomoko S.; Jin, Zhezhen; Ippolito, Paul; Dove, Lorna; Jorde, Ulrich P.; Takayama, Hiroo; Emond, Jean; Naka, Yoshifumi; Mancini, Donna; Lefkowitch, Jay H.; Christian Schulze, P.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 7, 01.07.2015, p. 873-882.

Research output: Contribution to journalArticle

Farr, M, Mitchell, J, Lippel, M, Kato, TS, Jin, Z, Ippolito, P, Dove, L, Jorde, UP, Takayama, H, Emond, J, Naka, Y, Mancini, D, Lefkowitch, JH & Christian Schulze, P 2015, 'Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction', Journal of Heart and Lung Transplantation, vol. 34, no. 7, pp. 873-882. https://doi.org/10.1016/j.healun.2014.12.009
Farr, Maryjane ; Mitchell, James ; Lippel, Matthew ; Kato, Tomoko S. ; Jin, Zhezhen ; Ippolito, Paul ; Dove, Lorna ; Jorde, Ulrich P. ; Takayama, Hiroo ; Emond, Jean ; Naka, Yoshifumi ; Mancini, Donna ; Lefkowitch, Jay H. ; Christian Schulze, P. / Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 7. pp. 873-882.
@article{da0311a22b26450891ed0b2e388712ae,
title = "Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction",
abstract = "Background Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. Methods Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. Results Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived 1 year post-HTx (74{\%}, as compared with 88{\%} average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score 45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95{\%} CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95{\%} CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4{\%} vs 3.7{\%}, p = 0.009), longer ventilation times (55.6{\%} vs 11.1{\%}, p = 0.013) and severe bleeding events (44.4{\%} vs 11.1{\%}, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). Conclusions Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction.",
keywords = "congestive hepatopathy, fibrosis, heart failure, liver disease, risk stratification",
author = "Maryjane Farr and James Mitchell and Matthew Lippel and Kato, {Tomoko S.} and Zhezhen Jin and Paul Ippolito and Lorna Dove and Jorde, {Ulrich P.} and Hiroo Takayama and Jean Emond and Yoshifumi Naka and Donna Mancini and Lefkowitch, {Jay H.} and {Christian Schulze}, P.",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.healun.2014.12.009",
language = "English (US)",
volume = "34",
pages = "873--882",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction

AU - Farr, Maryjane

AU - Mitchell, James

AU - Lippel, Matthew

AU - Kato, Tomoko S.

AU - Jin, Zhezhen

AU - Ippolito, Paul

AU - Dove, Lorna

AU - Jorde, Ulrich P.

AU - Takayama, Hiroo

AU - Emond, Jean

AU - Naka, Yoshifumi

AU - Mancini, Donna

AU - Lefkowitch, Jay H.

AU - Christian Schulze, P.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. Methods Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. Results Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived 1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score 45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). Conclusions Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction.

AB - Background Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. Methods Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. Results Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived 1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score 45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). Conclusions Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction.

KW - congestive hepatopathy

KW - fibrosis

KW - heart failure

KW - liver disease

KW - risk stratification

UR - http://www.scopus.com/inward/record.url?scp=84931561740&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84931561740&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2014.12.009

DO - 10.1016/j.healun.2014.12.009

M3 - Article

VL - 34

SP - 873

EP - 882

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 7

ER -