Heart transplantation in patients with liver cirrhosis

Abstract

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.

The liver in heart failure: a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation

“…Our data add to the existing evidence in the literature that patients with cardiac hepatopathy may, if carefully selected after considering additional clinical and laboratory parameters, be appropriate candidates for cardiac transplantation. 8,11,13,14 Our findings are in agreement with studies that have shown that after successful cardiac transplantation, patients may show improvement of liver disease in terms of both laboratory values and histologic findings. 11,13,14 Our patients all showed marked improvement in liver enzymes and bilirubin levels at 6 months and further improvement at 1 year post-transplant with normal levels observed in most patients.…”

“…The risk of perioperative death is markedly increased by cirrhosis due to any cause, [3][4][5] and cirrhosis is also associated with increased post-operative complications following cardiac surgery, [6][7][8][9] including increased rates of sepsis and bleeding. Serum bilirubin has been found to correlate with operative mortality and with the presence of cardiac cirrhosis in patients with primary pulmonary hypertension undergoing heartlung transplantation.…”

“…Serum bilirubin has been found to correlate with operative mortality and with the presence of cardiac cirrhosis in patients with primary pulmonary hypertension undergoing heartlung transplantation. 10 Few studies have examined the risk of surgery in patients with liver disease secondary to cardiac dysfunction alone, 8,11,12 and there is evidence that at least a subset of patients with liver disease due to cardiac dysfunction may be able to survive cardiac transplantation with reasonable outcomes. 8,[13][14][15] Additionally, liver enzyme abnormalities and hepatic synthetic function may return to normal if cardiac function normalizes after heart transplantation.…”

“…10 Few studies have examined the risk of surgery in patients with liver disease secondary to cardiac dysfunction alone, 8,11,12 and there is evidence that at least a subset of patients with liver disease due to cardiac dysfunction may be able to survive cardiac transplantation with reasonable outcomes. 8,[13][14][15] Additionally, liver enzyme abnormalities and hepatic synthetic function may return to normal if cardiac function normalizes after heart transplantation. 11,14 A liver biopsy may be performed in cardiac transplant candidates with heart failure in an attempt to assess the degree of liver injury related to chronic passive hepatic congestion.…”

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

“…Moreover, a post reperfusion injury, secondary coagulopathy, and post-operative hydrostatic pulmonary edema may worsen the clinical outcome [95]. In addition, cirrhotic patients with concomitant severe cardiomyopathy may benefit from cardiac transplantation [96]. receptor agonists are responsible for hydrogen sulfide production; moreover, NCX-1000 may release NO in the liver [97].…”