Outcomes of patients with cardiac cirrhosis undergoing heart transplantation

Abstract

IntroductionCardiac cirrhosis is common in patients with advanced heart failure and can limit heart transplant eligibility. We examined the outcomes of patients with cardiac cirrhosis following orthotopic heart transplantation.Material and methodsA retrospective matched cohort study of adult patients with cirrhosis undergoing heart transplantation at an Australian hospital from 2009 to 2017 was performed. Cirrhosis was established by either (a) histopathology or (b) combination of radiological features of cirrhosis and portal hypertension plus clinical features of portal hypertension. Primary objectives were to assess mortality, perioperative, and long‐term complications. Matching was performed with non‐cirrhotic patients undergoing heart transplantation in a 4:1 ratio.ResultsFive patients with biopsy‐proven cirrhosis or portal hypertension and 20 matched controls without cirrhosis were included. Additionally, 5 patients with clinical and radiological evidence of cirrhosis were assessed separately. The groups were well‐matched for age at transplant, year of transplant, gender, and comorbidities. Mortality was more frequent but not significantly greater in the cirrhosis group with 2 deaths within 4 months of transplant compared to 1 death each in the no cirrhosis and suspected cirrhosis groups (40%, 5%, 20% P = .40). The median duration of intensive care unit stay was longer in the cirrhosis group compared to the suspected cirrhosis group (8 vs 6 days, P = .03); however, there was no difference in total hospitalization (P = .56) or in median duration of admission (0.64) compared to the no cirrhosis group.ConclusionsThese findings suggest that there is greater mortality associated with cases of definite cirrhosis compared to suspected or matched controls following orthotopic heart transplantation; however, statistical significance was not reached. Admission length and complication rates were similar compared to those without cirrhosis. Future studies are warranted to further evaluate mortality risk in a larger population.

Congestive Hepatopathy

“…Not surprisingly, for most teams, the diagnosis of cirrhosis is considered a contraindication for HT [112]. In the setting of CH, there is even less data regarding outcomes of isolated HT in patients with established cardiac cirrhosis, but it may also lead to poorer outcomes [113]. The aforementioned limitations of available invasive and non-invasive tests to assess hepatic fibrosis and function make it especially challenging to determine whether a patient with CH is a candidate for isolated HT or may require a CHLT.…”