Heart transplantation in patients with liver cirrhosis
Journal
European Journal of Cardio-thoracic Surgery
Journal Volume
34
Journal Issue
2
Pages
307-312
Date Issued
2008
Author(s)
Abstract
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. ? 2008 European Association for Cardio-Thoracic Surgery.
SDGs
Other Subjects
azathioprine; cyclosporin; methylprednisolone sodium succinate; mycophenolic acid 2 morpholinoethyl ester; prednisone; tacrolimus; thymocyte antibody; acute kidney failure; adult; alcoholism; article; bacteremia; congenital heart disease; congestive cardiomyopathy; consciousness disorder; controlled study; coronary artery disease; decompensated liver cirrhosis; drug dose reduction; female; follow up; graft failure; heart failure; heart transplantation; human; intestine ischemia; laparotomy; liver cirrhosis; liver dysfunction; liver failure; major clinical study; male; mortality; outcome assessment; pericardial effusion; pneumonia; postoperative complication; postoperative hemorrhage; priority journal; seizure; sepsis; sternotomy; stroke; survival rate; unspecified side effect; urinary tract infection; valvular heart disease; wound infection; Adolescent; Adult; Epidemiologic Methods; Female; Heart Failure; Heart Transplantation; Humans; Immunosuppressive Agents; Liver Cirrhosis; Male; Middle Aged; Postoperative Care; Severity of Illness Index; Treatment Outcome
Type
journal article