Impact of Biopsy Proven Liver Fibrosis on Patients Undergoing Evaluation and Treatment for Advanced Heart Failure Surgical Therapies

Goyal, Amandeep; Dalia, Tarun; Ranka, Sagar; Sauer, Andrew J.; Hu, Jinxiang; Cernik, Colin; Nuqali, Abdulelah; Chandler, Jonathan; Parimi, Nikhil; Dennis, Katie; Majmundar, Monil; Tayeb, Taher; Haglund, Jennifer; Shah, Zubair; Vidic, Andrija; Gupta, Bhanu; Haglund, Nicholas

doi:10.1016/j.amjcard.2023.02.004

Cited by 3 publications

(1 citation statement)

References 43 publications

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“…This was likely a consequence of our institutional protocol in which candidates for HT with predominance of grade 4 fibrosis on LB underwent heart-liver transplant; in 12 candidates with advanced fibrosis on LB that underwent HT, 7 candidates (58%) underwent heart-liver transplant. However, advanced liver fibrosis alone 34 , or in conjunction with other clinical factors such as MELD 6 is a well-established risk factor for adverse outcomes after durable left ventricular assist device implantation or HT. As such, only 12 of the 26 candidates (46%) that were found to have advanced fibrosis on LB underwent HT, as compared to 64% of candidates without advanced fibrosis on LB.…”

Section: Discussionmentioning

confidence: 99%

Utility of a Score-Based Approach to Liver Assessment in Heart Transplant Candidates

Rushakoff,

Cao,

Ebinger

et al. 2023

Preprint

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Background: While abnormalities of liver function and imaging are common in patients with end-stage heart failure, advanced fibrosis is uncommon. Liver biopsy (LB) is used to identify advanced fibrosis in heart transplant (HT) candidates but can delay or limit access to definitive therapies and cause complications. We sought to develop and determine the utility of a clinical risk score for advanced fibrosis in HT candidates. Methods: We conducted a retrospective, single-center review of patients evaluated for HT between 2012 and 2019 (n = 1,651) and identified those who underwent LB (n = 137) as well as a matched control cohort (n = 160). All biopsies were reviewed by a liver pathologist. Kaplan-Meir curves were used to assess survival. Univariate logistic modeling was used to identify factors predictive of advanced liver fibrosis. Simulation using synthetic data bootstraps was performed to determine the utility of using a score-based approach to trigger LB. Results: We identified 32 (23%) patients with stage 0, 79 (58%) with stage 1-2, and 26 (19%) with stage 3-4/advanced fibrosis. We found no difference in survival at 3 years post-HT based on pre-HT fibrosis stage. The factor most associated with pursuit of LB was abnormal liver parenchyma on ultrasound. We found that a score combining severe tricuspid regurgitation, alcohol use, and low-density lipoprotein improved specificity and reduced the number of LBs required. Conclusions: A score composed of non-invasive factors may help reduce the number of patients who require LB for diagnosis of advanced fibrosis. Additional multicenter studies are needed to validate this score.

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Section: Discussionmentioning

confidence: 99%