TY - JOUR
T1 - Hepatic dysfunction and survival after orthotopic heart transplantation
T2 - Application of the MELD scoring system for outcome prediction
AU - Chokshi, Aalap
AU - Cheema, Faisal H.
AU - Schaefle, Kenneth J.
AU - Jiang, Jeffrey
AU - Collado, Elias
AU - Shahzad, Khurram
AU - Khawaja, Tuba
AU - Farr, Maryjane
AU - Takayama, Hiroo
AU - Naka, Yoshifumi
AU - Mancini, Donna M.
AU - Schulze, P. Christian
N1 - Funding Information:
This work was supported by the Irving Institute for Clinical and Translational Research at Columbia University ( UL1 RR 024156 ), and grants from the NHLBI to P.C.S. ( K23 HL095742-01 and P30 HL101272-01 ). A.S. was supported by the Doris Duke Medical Foundation.
PY - 2012/6
Y1 - 2012/6
N2 - 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.
AB - 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.
KW - MELD
KW - heart failure
KW - heart transplantation
KW - liver dysfunction
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=84861190158&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861190158&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2012.02.008
DO - 10.1016/j.healun.2012.02.008
M3 - Article
C2 - 22458996
AN - SCOPUS:84861190158
SN - 1053-2498
VL - 31
SP - 591
EP - 600
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -