Liver abnormalities and post-transplant survival in pediatric Fontan patients

Area of Science:

• Cardiology
• Hepatology
• Pediatric Transplant Surgery

Background:

• Liver parenchymal abnormalities' impact on survival post-heart transplant in pediatric Fontan patients is not well understood.
• Pretransplant hepatic ultrasound (U/S) is a key diagnostic tool.

Purpose of the Study:

• To assess the impact of pretransplant liver parenchymal abnormalities, identified via ultrasound, on survival outcomes in pediatric Fontan patients following heart transplant.

Main Methods:

• Retrospective analysis of 30 pediatric Fontan patients who underwent heart transplant.
• Classification of pretransplant liver ultrasound findings into normal, mildly abnormal, or severely abnormal groups.
• Correlation of ultrasound findings with liver biochemistry, synthetic function, biopsy results, and survival data.

Main Results:

• The majority of patients (22/30) showed abnormal pretransplant liver ultrasound findings.
• Severe abnormalities (heterogeneous echotexture/nodularity) were present in 8 patients, with biopsy confirming fibrosis or cirrhosis in 6.
• One-year survival was similar across all groups (P=.37), with a trend towards better 5-year survival in the normal ultrasound group.

Conclusions:

• Pretransplant liver ultrasound frequently detects parenchymal abnormalities in pediatric Fontan patients awaiting heart transplant.
• Severe liver abnormalities identified on ultrasound do not appear to increase early post-transplant mortality.
• Further investigation is needed to understand the long-term survival implications of these findings.