Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for...

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Heart failure (HF) prevalence is increasing, with cardiac transplantation as the primary treatment.
• Advanced HF can cause congestive hepatopathy and liver damage, potentially impacting transplant outcomes.
• Hepatic dysfunction in HF patients may be associated with impaired clinical outcomes post-cardiac transplantation.

Purpose of the Study:

• To investigate the association between pre-operative hepatic dysfunction and clinical outcomes in adult patients undergoing orthotopic heart transplantation (OHT).
• To analyze the dynamics of liver function abnormalities before and after OHT.
• To evaluate the predictive value of MELD and modified MELD scores for post-transplant outcomes.

Main Methods:

• Retrospective analysis of 617 adult patients undergoing OHT.
• Definition of abnormal liver function based on deviation from institutional normal ranges.
• Calculation of standard Model for End-stage Liver Disease (MELD) and a modified MELD (modMELD) score, replacing INR with albumin.

Main Results:

• Pre-OHT, elevated AST, ALT, and total bilirubin were observed in 20%, 18%, and 29% of patients, respectively.
• Decreased total protein and albumin were noted in 25% and 52% of patients; normalization took longer for ALT, total protein, and albumin post-transplant.
• Higher pre-transplant MELD or modMELD scores correlated with worse 30-day outcomes and reduced 10-year survival.

Conclusions:

• Pre-operative liver dysfunction is common in OHT candidates and significantly impacts post-transplant survival.
• Elevated MELD scores effectively indicate impaired liver function and predict poor clinical outcomes after OHT.
• Understanding and addressing pre-operative liver function is crucial for improving patient survival following cardiac transplantation.