Prevalence and Causes of Long‐Lasting Hepatic Dysfunction after Heart Transplantation: A Series of 80 Patients

Abstract

The long-term follow-up of 80 heart transplant patients (70 men, 10 women) from January 1982 to July 1985 who had received cyclosporine (CsA) showed a high incidence of mild to severe liver dysfunction. Fifty patients (62.5%) had long-lasting postoperative biological disturbances (alanine amino transferase greater than 2N and/or alkaline phosphatase greater than 1.5N for 3 months or more). Most patients were asymptomatic; eight were icteric, and one had arthralgia. The most common biological feature consisted of isolated elevation of ALAT (27 cases). Assessment of causes led to a definite etiology in 42 patients: 7 cardiac failure, 13 HBsAg-positive liver disease (26%) (chronic persistent hepatitis 8, chronic active hepatitis 2, subacute necrosis 2). Fourteen patients (28%) sustained non-A, non-B (NANB) hepatitis (chronic persistent hepatitis 5, chronic active hepatitis 1, cirrhosis 1), and 7 (14%) sustained a drug-related hepatitis. Liver biopsy and complete virus screening was contributive to the diagnosis in nearly all patients. Additionally, prolonged impairment of liver function tests occurred in 62% of heart transplant recipients, mostly during the first 6 postoperative months. Hepatitis B virus (HBV) and NANB hepatitis accounted for 26% and 28% of the cases of liver dysfunction, respectively; drug-induced hepatitis may have been involved in 14% of the cases. Complete hepatitis virus screening should be performed before heart transplant and in any case of abnormal liver function posttransplantation. HBV vaccination prior to heart transplant is recommended in HBsAg- and HBcAb-negative candidates for heart replacement. Long-term follow-up of these patients is mandatory to assess the severity of these liver dysfunctions.

Association between the cumulative dose of cyclosporine and liver enzyme abnormalities in dermatology patients managed with a low‐dose regimen

“…Lorber et al 12 reported that 49% of renal transplant recipients developed liver test abnormalities, including ALT. Cadranel et al 15 reported that 62.5% of heart transplant recipients developed liver test abnormalities. As the dosage and duration of CsA is much higher and longer in transplant recipients than in dermatology patients, we could infer that a higher cumulative dose of CsA may increase the risk of liver injury, as reflected by abnormal liver enzyme levels.…”

Effects of ursodeoxycholic acid (ursodiol) treatment on chronic viral hepatitis in heart transplant patients: results of a prospective, double-blind, placebo-randomized study

“…Exclusion criteria were as follows: (1) multiorgan transplantation; (2) poor expected survival (Ͻ6 months); (3) coinfection with human immunodeficiency virus; (4) alcohol intake more than 30 g per day; (5) positivity for smooth muscle antibodies, antimitochondrial antibodies, antinuclear antibodies, or antimicrosome antibodies; (6) markers of alpha-1 antitrypsin deficiency, Wilson disease, or genetic hemochromatosis; (7) chronic allograft rejection responsible for increase in serum ALT (1,28); and (8) refusal to participate in the study.…”

“…Bile acid analysis was performed on serum samples stored at Ϫ80°C, using high-performance liquid chromatography and direct spectrometry, as previously described (28).…”