Kathleen E Simpson1, Amir Esmaeeli2, Geetika Khanna3, Francis White4, Yumirle Turnmelle5, Pirooz Eghtesady6, Umar Boston6, Charles E Canter5. 1. Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri. Electronic address: simpson_k@kids.wustl.edu. 2. School of Medicine, Washington University School of Medicine, Saint Louis, Missouri. 3. Department of Radiology, Washington University School of Medicine, Saint Louis, Missouri. 4. Department of Pathology, Washington University School of Medicine, Saint Louis, Missouri. 5. Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri. 6. Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
Abstract
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.
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 cirrhosispatients. Characteristics at listing between normal or non-cirrhotic (n = 13) and cirrhosis (n = 7) groups were similar, except cirrhosispatients 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-cirrhosispatients (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.
Authors: Salil Ginde; Mark D Hohenwalter; W Dennis Foley; Jane Sowinski; Peter J Bartz; Suneetha Venkatapuram; Catherine Weinberg; James S Tweddell; Michael G Earing Journal: Congenit Heart Dis Date: 2012-02-23 Impact factor: 2.007
Authors: Jacqueline M Lamour; Kirk R Kanter; David C Naftel; Maryanne R Chrisant; William R Morrow; Barry S Clemson; James K Kirklin Journal: J Am Coll Cardiol Date: 2009-07-07 Impact factor: 24.094
Authors: M G Crespo-Leiro; O Robles; M J Paniagua; R Marzoa; C Naya; X Flores; F Suárez; M Gómez; Z Grille; J J Cuenca; A Castro-Beiras; F Arnal Journal: Am J Transplant Date: 2008-04-29 Impact factor: 8.086
Authors: T J Kendall; B Stedman; N Hacking; M Haw; J J Vettukattill; A P Salmon; R Cope; N Sheron; H Millward-Sadler; G R Veldtman; J P Iredale Journal: J Clin Pathol Date: 2007-10-26 Impact factor: 3.411
Authors: Christoph H Kiesewetter; Nick Sheron; Joseph J Vettukattill; Nigel Hacking; Brian Stedman; Harry Millward-Sadler; Marcus Haw; Richard Cope; Anthony P Salmon; Muthukumaran C Sivaprakasam; Tim Kendall; Barry R Keeton; John P Iredale; Gruschen R Veldtman Journal: Heart Date: 2006-09-27 Impact factor: 5.994
Authors: Christine Y Louie; Michael X Pham; Tami J Daugherty; Neeraja Kambham; John P T Higgins Journal: Mod Pathol Date: 2015-03-20 Impact factor: 7.842