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Part 2: Disease of the Heart and Liver: A Relationship That Cuts Both Ways
Nicholas Scalzo1, Mehtap Canastar, Edward Lebovics
1From the Department of Medicine, Section of Gastroenterology & Hepatobiliary Diseases, New York Medical College and Westchester Medical Center, Valhalla, NY.
Insights
Transplant can be a viable option for heart and liver diseases. Cardiac transplant may improve liver enzymes, while liver transplant requires careful heart evaluation, and combined transplants need more study.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Heart and liver diseases often coexist, stemming from infections, autoimmune conditions, metabolic disorders, or toxins like alcohol.
- Progressive damage to both organs may necessitate transplantation as a therapeutic strategy.
- Congestive hepatopathy in heart failure patients can improve post-cardiac transplant.
Purpose of the Study:
- To review the clinical considerations for patients with combined heart and liver disease requiring transplantation.
- To discuss preoperative cardiac evaluation for liver transplant candidates.
- To explore advancements in noninvasive liver fibrosis assessment and the potential of combined heart-liver transplantation.
Main Methods:
- Review of existing literature on heart and liver diseases and transplantation.
- Discussion of clinical management strategies for patients with comorbid cardiac and hepatic conditions.
- Examination of noninvasive diagnostic techniques for liver fibrosis, including transient elastography.
- Analysis of current research on combined heart-liver transplant outcomes.
Main Results:
- Cardiac transplant can lead to improved liver enzyme levels in patients with congestive hepatopathy.
- Liver transplant recipients require thorough cardiac assessment due to potential myocardial stress.
- Noninvasive methods like serum markers and transient elastography are increasingly replacing liver biopsy for fibrosis assessment.
- Combined heart-liver transplantation is an emerging area with a need for more long-term outcome data.
Conclusions:
- Careful consideration of both cardiac and hepatic complications is crucial for managing patients with heart failure, cirrhosis, or nonalcoholic fatty liver disease.
- Noninvasive fibrosis assessment tools offer reduced morbidity compared to liver biopsy.
- Combined heart-liver transplantation shows promise but requires further investigation through longitudinal studies.
Abstract:
Diseases known to affect both the heart and liver include a variety of infectious, autoimmune, and metabolic disorders, as well as toxins: most commonly alcohol. As damage to both the heart and liver progresses, transplantation is a reasonable therapeutic option. Heart failure patients with underlying congestive hepatopathy receiving cardiac transplant have demonstrated improved liver enzyme levels posttransplant. Patients with severe end-stage liver disease requiring a liver transplant must undergo careful preoperative evaluation as surgical stress exposes the myocardium to high levels of catecholamines. Clinicians must consider both cardiac and hepatic complications when evaluating heart failure, cirrhosis, and nonalcoholic fatty liver disease. In Part 2 of this review, we discuss new noninvasive techniques for assessing liver fibrosis in the preoperative stage. Both serum and radiologic studies, such as transient elastography, have begun to take the place of liver biopsy due to their decreased morbidity. Last, we explore the current research examining the benefit of combined heart-liver transplant, although more longitudinal outcome studies are needed.
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