Improvement in hepatic and renal function following isolated heart transplant in adults with congenital heart disease. (1st October 2022)

• Record Type: Journal Article
• Authors: Egbe, Alexander C.; Miranda, William R.; Jain, C. Charles; Kamath, Patrick S.; Katta, Renuka R.; Andi, Kartik; Goda, Ahmed Y.; Connolly, Heidi M.
• Is Part Of: International journal of cardiology. Volume 364(2022)
• Page Start: 44
• Page End: 49
• Publication Date: 2022-10-01
• Subjects: Heart failure -- Heart transplant -- Hepatic function -- Renal function; CHD congenital heart disease -- MELD-XI model for end-stage liver disease excluding international normalized ratio -- APRI aspartate transaminase to platelet ratio index -- FIB-4 Fibrosis-4 -- GFR glomerular filtration rate; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.06.024
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: There are limited data about postoperative changes in hepatic and renal function in adults with congenital heart disease (CHD) undergoing isolated heart transplant. The purpose of this study was to assess postoperative changes in hepatic and renal function in this population. Methods: Retrospective cohort study of adults with CHD undergoing isolated heart transplant at Mayo Clinic (2003–2019). Global hepatic function was assessed using the model for end-stage liver disease excluding international normalized ratio [MELD-XI]) score; hepatic fibrosis was assessed using the fibrosis-4 (FIB-4) score and aspartate/platelet ratio index (APRI); and renal function was assessed using estimated glomerular filtration rate (GFR). All indices were measured preoperatively and postoperatively (at 6 months, 1 year, 2 years). Results: Of 40 patients (age 41 ± 8 years) in the study, 35 had complete preoperative and postoperative data. There was a temporal improvement in hepatic and renal indices from preop (MELD-XI 14 ± 5, APRI 0.60 ± 0.23, FIB-4 1.44 ± 0.38, GFR 59 [44–83]) to 6 months postop (MELD-XI 12 ± 6, APRI 0.49 ± 0.17, FIB-4 1.29 ± 0.33, GFR 68 [54–96]) and 1-year postop (MELD-XI 9 ± 3, APRI 0.41 ± 0.16, FIB-4 1.12 ± 0.29, GFR 82 [69–108]), p < 0.05 for all comparisons. Conclusions: CHD patients undergoing isolated heart transplant had significant improvement in hepatic and renal function. These data suggests that selected CHD patients may do well with isolated heart transplant despite reduced hepatic and renal function, and hepatic fibrosis preoperatively. More rigorous prospective studies are required to determine the relative outcomes of isolated versus combined heart-liver transplant in this population. Highlights: Adults with CHD undergoing isolated heart transplant had significant improvement in hepatic and renal function. There was a continuous improvement in hepatic and renal function for several months after normalization of cardiac hemodynamics. Selected CHD patients with hepatic and renal dysfunction may do well with isolated heart transplant alone.