Hepatic and cardiac iron overload among patients with end-stage liver disease referred for liver transplantation

Avital Y. O'Glasser, David L. Scott, Christopher L. Corless, Atif Zaman, Anna Sasaki, Deepak V. Gopal, Stephen C. Rayhill, Susan L. Orloff, John M. Ham, John M. Rabkin, Ken Flora, Crispin H. Davies, Craig S. Broberg, Jonathan M. Schwartz

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Iron overload is associated with fatal cardiovascular events following liver transplantation. Myocardial iron deposits were observed post-mortem in patients who died of cardiac events after transplantation at our institution. This observation prompted testing to exclude cardiac iron in subsequent transplant candidates.Aims: To assess the results of testing for iron overload in liver transplant candidates at our institution.Methods: Ferritin, TIBC, and serum iron were measured in cirrhotics referred for transplantation. Patients with transferrin saturation ≥50% and ferritin ≥250 ng/mL underwent liver biopsy graded for iron. Patients with 3-4+ hepatic iron deposits underwent HFE mutation analysis and endomyocardial biopsy with iron staining.Results: Eight hundred and fifty-six patients were evaluated for liver transplantation between January 1997 and March 2005. Two hundred and eighty-seven patients (34%) had transferrin saturation ≥50% and ferritin ≥250 ng/mL. Patients with markers of iron overload had more advanced liver disease than those with normal iron indices. One hundred and fifty-three patients underwent liver biopsy. Twenty-six patients (17%) had 3-4+ hepatic iron staining. One patient was a C282Y heterozygote. Endomyocardial biopsy was performed in 14 patients of whom nine had cardiac iron deposition.Conclusions: Non-HFE-related cardiac iron overload can occur in advanced liver disease We therefore recommend screening for cardiac iron prior to liver transplantation.

Original languageEnglish (US)
Pages (from-to)643-651
Number of pages9
JournalClinical Transplantation
Volume24
Issue number5
DOIs
StatePublished - Sep 2010
Externally publishedYes

Fingerprint

End Stage Liver Disease
Iron Overload
Liver Transplantation
Iron
Liver
Ferritins
Biopsy
Transferrin
Liver Diseases
Transplantation
Staining and Labeling
Transplants
Heterozygote
Mutation

Keywords

  • Hemochromatosis
  • Hemosiderosis
  • Liver transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Hepatic and cardiac iron overload among patients with end-stage liver disease referred for liver transplantation. / O'Glasser, Avital Y.; Scott, David L.; Corless, Christopher L.; Zaman, Atif; Sasaki, Anna; Gopal, Deepak V.; Rayhill, Stephen C.; Orloff, Susan L.; Ham, John M.; Rabkin, John M.; Flora, Ken; Davies, Crispin H.; Broberg, Craig S.; Schwartz, Jonathan M.

In: Clinical Transplantation, Vol. 24, No. 5, 09.2010, p. 643-651.

Research output: Contribution to journalArticle

O'Glasser, AY, Scott, DL, Corless, CL, Zaman, A, Sasaki, A, Gopal, DV, Rayhill, SC, Orloff, SL, Ham, JM, Rabkin, JM, Flora, K, Davies, CH, Broberg, CS & Schwartz, JM 2010, 'Hepatic and cardiac iron overload among patients with end-stage liver disease referred for liver transplantation', Clinical Transplantation, vol. 24, no. 5, pp. 643-651. https://doi.org/10.1111/j.1399-0012.2009.01136.x
O'Glasser, Avital Y. ; Scott, David L. ; Corless, Christopher L. ; Zaman, Atif ; Sasaki, Anna ; Gopal, Deepak V. ; Rayhill, Stephen C. ; Orloff, Susan L. ; Ham, John M. ; Rabkin, John M. ; Flora, Ken ; Davies, Crispin H. ; Broberg, Craig S. ; Schwartz, Jonathan M. / Hepatic and cardiac iron overload among patients with end-stage liver disease referred for liver transplantation. In: Clinical Transplantation. 2010 ; Vol. 24, No. 5. pp. 643-651.
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AU - O'Glasser, Avital Y.

AU - Scott, David L.

AU - Corless, Christopher L.

AU - Zaman, Atif

AU - Sasaki, Anna

AU - Gopal, Deepak V.

AU - Rayhill, Stephen C.

AU - Orloff, Susan L.

AU - Ham, John M.

AU - Rabkin, John M.

AU - Flora, Ken

AU - Davies, Crispin H.

AU - Broberg, Craig S.

AU - Schwartz, Jonathan M.

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N2 - Background: Iron overload is associated with fatal cardiovascular events following liver transplantation. Myocardial iron deposits were observed post-mortem in patients who died of cardiac events after transplantation at our institution. This observation prompted testing to exclude cardiac iron in subsequent transplant candidates.Aims: To assess the results of testing for iron overload in liver transplant candidates at our institution.Methods: Ferritin, TIBC, and serum iron were measured in cirrhotics referred for transplantation. Patients with transferrin saturation ≥50% and ferritin ≥250 ng/mL underwent liver biopsy graded for iron. Patients with 3-4+ hepatic iron deposits underwent HFE mutation analysis and endomyocardial biopsy with iron staining.Results: Eight hundred and fifty-six patients were evaluated for liver transplantation between January 1997 and March 2005. Two hundred and eighty-seven patients (34%) had transferrin saturation ≥50% and ferritin ≥250 ng/mL. Patients with markers of iron overload had more advanced liver disease than those with normal iron indices. One hundred and fifty-three patients underwent liver biopsy. Twenty-six patients (17%) had 3-4+ hepatic iron staining. One patient was a C282Y heterozygote. Endomyocardial biopsy was performed in 14 patients of whom nine had cardiac iron deposition.Conclusions: Non-HFE-related cardiac iron overload can occur in advanced liver disease We therefore recommend screening for cardiac iron prior to liver transplantation.

AB - Background: Iron overload is associated with fatal cardiovascular events following liver transplantation. Myocardial iron deposits were observed post-mortem in patients who died of cardiac events after transplantation at our institution. This observation prompted testing to exclude cardiac iron in subsequent transplant candidates.Aims: To assess the results of testing for iron overload in liver transplant candidates at our institution.Methods: Ferritin, TIBC, and serum iron were measured in cirrhotics referred for transplantation. Patients with transferrin saturation ≥50% and ferritin ≥250 ng/mL underwent liver biopsy graded for iron. Patients with 3-4+ hepatic iron deposits underwent HFE mutation analysis and endomyocardial biopsy with iron staining.Results: Eight hundred and fifty-six patients were evaluated for liver transplantation between January 1997 and March 2005. Two hundred and eighty-seven patients (34%) had transferrin saturation ≥50% and ferritin ≥250 ng/mL. Patients with markers of iron overload had more advanced liver disease than those with normal iron indices. One hundred and fifty-three patients underwent liver biopsy. Twenty-six patients (17%) had 3-4+ hepatic iron staining. One patient was a C282Y heterozygote. Endomyocardial biopsy was performed in 14 patients of whom nine had cardiac iron deposition.Conclusions: Non-HFE-related cardiac iron overload can occur in advanced liver disease We therefore recommend screening for cardiac iron prior to liver transplantation.

KW - Hemochromatosis

KW - Hemosiderosis

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