Association of liver biopsy pathology on outcome of patients undergoing heart transplantation
Background: Patients with advanced heart failure needing heart transplant commonly suffer liver dysfunction. However, there is limited data on the impact of liver fibrosis on outcomes for heart transplant (HT) candidates. We determine the relationship between liver fibrosis severity and mortality ra...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001368 |
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| author | Lauren S. Eichenwald, MD Raffi Karagozian, MD Adam J. Eichenwald, PhD John Morrissey, MD MBA Saurav Kini, MD Ariella Stein, MSCIS-HI Amanda R. Vest, MBBS MPH |
| author_facet | Lauren S. Eichenwald, MD Raffi Karagozian, MD Adam J. Eichenwald, PhD John Morrissey, MD MBA Saurav Kini, MD Ariella Stein, MSCIS-HI Amanda R. Vest, MBBS MPH |
| author_sort | Lauren S. Eichenwald, MD |
| collection | DOAJ |
| description | Background: Patients with advanced heart failure needing heart transplant commonly suffer liver dysfunction. However, there is limited data on the impact of liver fibrosis on outcomes for heart transplant (HT) candidates. We determine the relationship between liver fibrosis severity and mortality rates for HT patients. Methods: A retrospective cohort study of adults listed for HT who underwent a liver biopsy for evaluation of early or advanced liver fibrosis from August 12, 2004 to February 16, 2022. Trend analysis was performed using Cox proportional hazard model, controlling for MELD-XI. At-risk period starts at the time of waitlist; the end of the follow-up period was mortality on the waitlist, mortality post-HT, or administrative censoring at the end of the study. Results: There was no significant difference in the survival of patients with advanced fibrosis and early fibrosis over time (HR 1.54, CI 0.59–4.02, p = 0.5). Similarly, there was also no significant survival difference within groups who did (HR 0.78, CI = 0.26–2.33, p = 0.8) or did not (HR 1.00, CI 0.09–11.43, p = 0.9) receive transplants. However, most transplants were performed in patients with no or early fibrosis. Conclusion: There was no significant difference in the survival rates between HT candidates with and without advanced fibrosis on the waitlist and post-HT, challenging the notion that advanced fibrosis should be an absolute contraindication for HT. However, our findings are limited by the small sample size, retrospective design, and focus on patients already deemed suitable for transplantation. These limitations highlight the need for prospective studies involving broader patient populations, including those excluded from transplant candidacy due to severe fibrosis or cirrhosis. Future research should evaluate whether pre-transplant liver biopsy is necessary for all HT candidates or if clinical assessments can adequately stratify risk. Lay summary: This study found that the presence of advanced liver injury did not confer a difference in the waitlist and post heart transplant (HT) survival rates of patients on the HT transplant list. This finding suggests that patients listed for transplant may not need to undergo a liver biopsy as part of the transplant work up. |
| format | Article |
| id | doaj-art-98cfd3244b514292acfa3e0db4303648 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-98cfd3244b514292acfa3e0db43036482025-02-09T05:01:57ZengElsevierJHLT Open2950-13342025-02-017100187Association of liver biopsy pathology on outcome of patients undergoing heart transplantationLauren S. Eichenwald, MD0Raffi Karagozian, MD1Adam J. Eichenwald, PhD2John Morrissey, MD MBA3Saurav Kini, MD4Ariella Stein, MSCIS-HI5Amanda R. Vest, MBBS MPH6Department of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Corresponding author: Lauren S. Eichenwald, MD, Department of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.Department of Medicine, Tufts Medical Center, Boston, MassachusettsDepartment of Wildlife, Fisheries, and Conservation Biology, University of Maine, Orono, MaineDepartment of Medicine, Tufts Medical Center, Boston, MassachusettsDepartment of Medicine, Tufts Medical Center, Boston, MassachusettsDepartment of Medicine, Tufts Medical Center, Boston, MassachusettsDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OhioBackground: Patients with advanced heart failure needing heart transplant commonly suffer liver dysfunction. However, there is limited data on the impact of liver fibrosis on outcomes for heart transplant (HT) candidates. We determine the relationship between liver fibrosis severity and mortality rates for HT patients. Methods: A retrospective cohort study of adults listed for HT who underwent a liver biopsy for evaluation of early or advanced liver fibrosis from August 12, 2004 to February 16, 2022. Trend analysis was performed using Cox proportional hazard model, controlling for MELD-XI. At-risk period starts at the time of waitlist; the end of the follow-up period was mortality on the waitlist, mortality post-HT, or administrative censoring at the end of the study. Results: There was no significant difference in the survival of patients with advanced fibrosis and early fibrosis over time (HR 1.54, CI 0.59–4.02, p = 0.5). Similarly, there was also no significant survival difference within groups who did (HR 0.78, CI = 0.26–2.33, p = 0.8) or did not (HR 1.00, CI 0.09–11.43, p = 0.9) receive transplants. However, most transplants were performed in patients with no or early fibrosis. Conclusion: There was no significant difference in the survival rates between HT candidates with and without advanced fibrosis on the waitlist and post-HT, challenging the notion that advanced fibrosis should be an absolute contraindication for HT. However, our findings are limited by the small sample size, retrospective design, and focus on patients already deemed suitable for transplantation. These limitations highlight the need for prospective studies involving broader patient populations, including those excluded from transplant candidacy due to severe fibrosis or cirrhosis. Future research should evaluate whether pre-transplant liver biopsy is necessary for all HT candidates or if clinical assessments can adequately stratify risk. Lay summary: This study found that the presence of advanced liver injury did not confer a difference in the waitlist and post heart transplant (HT) survival rates of patients on the HT transplant list. This finding suggests that patients listed for transplant may not need to undergo a liver biopsy as part of the transplant work up.http://www.sciencedirect.com/science/article/pii/S2950133424001368heart failureliver fibrosiscirrhosisMELD-XIheart transplant |
| spellingShingle | Lauren S. Eichenwald, MD Raffi Karagozian, MD Adam J. Eichenwald, PhD John Morrissey, MD MBA Saurav Kini, MD Ariella Stein, MSCIS-HI Amanda R. Vest, MBBS MPH Association of liver biopsy pathology on outcome of patients undergoing heart transplantation JHLT Open heart failure liver fibrosis cirrhosis MELD-XI heart transplant |
| title | Association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| title_full | Association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| title_fullStr | Association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| title_full_unstemmed | Association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| title_short | Association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| title_sort | association of liver biopsy pathology on outcome of patients undergoing heart transplantation |
| topic | heart failure liver fibrosis cirrhosis MELD-XI heart transplant |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001368 |
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