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Published on: August 17, 2022
Heart transplantation in patients with liver cirrhosis
Ron-Bin Hsu1, Chung-I Chang, Fang-Yue Lin
1Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC. ronbin@ntuh.gov.tw
Insights
Heart transplantation in patients with liver cirrhosis showed high hospital mortality (50%) but survivors improved to Child class A. Careful patient selection is crucial for considering heart transplants in cirrhotic patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Liver cirrhosis is traditionally a contraindication for heart transplantation.
- Limited data exists on the clinical outcomes of heart transplantation in patients with liver cirrhosis.
Purpose of the Study:
- To evaluate the clinical outcomes of heart transplantation in patients diagnosed with liver cirrhosis.
Main Methods:
- Retrospective chart review of patients with liver cirrhosis undergoing heart transplantation between 1987 and 2007.
- Data included diagnosis of liver cirrhosis, causes of heart failure and cirrhosis, and Child classification.
Main Results:
- Twelve patients with liver cirrhosis underwent heart transplantation; hospital mortality was 50% with 75% experiencing major in-hospital complications.
- High mortality was associated with non-cardiomyopathy, previous sternotomy, and massive ascites.
- No late deaths occurred; survivors improved to Child class A, with no late liver dysfunction.
Conclusions:
- Heart transplantation in patients with end-stage heart failure and liver cirrhosis is feasible.
- Careful patient selection is essential due to high perioperative mortality and morbidity.
- Survivors demonstrate improved liver function post-transplant.
Objective:
Liver cirrhosis is considered to be a contraindication to heart transplantation. However, the clinical outcome of heart transplantation in patients with liver cirrhosis has not been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in cirrhotic patients.
Methods:
Data were collected by retrospective chart review. Patients with liver cirrhosis at the time of transplantation were included.
Results:
Between 1987 and 2007, 12 patients with liver cirrhosis underwent heart transplantation at the authors' hospital. Diagnosis of liver cirrhosis was based on preoperative abdominal sonography in five, autopsy in five, and laparotomy in two patients. Causes of heart failure were dilated cardiomyopathy in four, coronary artery disease in three, congenital heart disease in three and valvular heart disease in two patients. Causes of liver cirrhosis were alcoholism in two, cardiac in seven, and unknown in three patients. The Child classification was class A in three, class B in five and class C in four patients. Overall, the hospital mortality rate was 50% and major in-hospital complications occurred in nine patients (75%). Patients with non-cardiomyopathy diagnosis, previous sternotomy, and massive ascites had a high hospital mortality rate. The median follow-up duration was 33.5 months. There was no late death. Late post-transplant complications occurred in four patients and there was no event of liver dysfunction. All survivors were in Child class A at outpatient follow-up.
Conclusions:
Although there was high mortality and morbidity, patients with end-stage heart failure and liver cirrhosis can be considered for heart transplantation with careful case selection.
