The liver in heart failure: a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

“…Given the underlying pathophysiology of CH and limited correlation of individual serum markers with fibrosis stage, clinical risk calculators are unlikely to effectively predict fibrosis risk in CH . For example, several models heavily weight aminotransferase values as markers of liver necroinflammation, but CH is not an inflammatory disease . Among 27 patients with FALD, the positive predictive value (PPV) and negative predictive value (NPV) of FibroSure for identifying evolving or established cirrhosis when compared to liver biopsy were 33.3% (PPV) and 52.6% (NPV).…”

“…Vasoconstriction results in zone 3 sinusoidal ischemia and fibrosis deposition, leading to bridging fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC). In addition, low cardiac output itself may also lead to low circulating blood flow to the liver, accelerating fibrosis pathways …”

“…This information is critical in determining a specific patient's prognosis, screening and management strategy, and ultimately their candidacy for isolated heart versus combined heart–liver transplant as cardiac disease worsens. Unlike the inflammatory hepatopathies (e.g., viral, alcoholic, and nonalcoholic fatty liver disease [NAFLD]) which have validated biomarkers of fibrosis and clinical outcomes (serum tests, fibrosis calculators, and liver stiffness assessments), there is a growing awareness that these tools are unreliable in CH . There is also evidence suggesting that even liver biopsy, which is touted as the gold standard for fibrosis assessment, may be unable to accurately stage fibrosis and predict clinical outcomes in CH .…”

Short‐term outcomes of en bloc combined heart and liver transplantation in the failing Fontan

“…17,18 Since a patient taking vitamin K antagonists will have elevated INR, the MELD-XI is used which excludes INR using the formula: (5.11 Ln [bilirubin] + 11.6 Ln [Creatinine] + 9.44). 21 The information from this evaluation ( Figure 1) is presented at a multidisciplinary conference where a final decision for eligibility and listing status for en bloc CHLT is made. 20 The definition of liver cirrhosis and/or portal hypertension on advanced imaging included a nodular liver surface with heterogeneous density, alteration in hepatic or portal vein flow, portal vein dilation, splenomegaly, the presence of any portosystemic collaterals, and/or ascites.…”

“…Post-operatively six patients were extubated at a median of 3 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and the other three required tracheostomy at a median of 17 days (14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Post-operatively six patients were extubated at a median of 3 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and the other three required tracheostomy at a median of 17 days (14)(15)…”