Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction
| Autor: | Jean C. Emond, Lorna Dove, Tomoko S. Kato, Hiroo Takayama, Yoshifumi Naka, Zhezhen Jin, James M. Mitchell, Maryjane Farr, Ulrich P. Jorde, Matthew Lippel, Paul Ippolito, Jay H. Lefkowitch, P. Christian Schulze, Donna Mancini |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Biopsy medicine.medical_treatment Risk Assessment Severity of Illness Index Article End Stage Liver Disease Liver disease Risk Factors Internal medicine medicine Humans Retrospective Studies Heart Failure Heart transplantation Transplantation Framingham Risk Score medicine.diagnostic_test business.industry Middle Aged Prognosis medicine.disease Liver Congestive hepatopathy Heart failure Liver biopsy Cardiology Heart Transplantation Female Surgery Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Journal of Heart and Lung Transplantation. 34:873-882 |
| ISSN: | 1053-2498 |
| Popis: | Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx.Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient.Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived ≥1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score ≥45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p0.001) analyses. Patients who died1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p0.001).Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction. |
| Databáze: | OpenAIRE |
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