Pre-Transplant Evaluation of Patients Undergoing Combined Heart-Liver Transplantation and Correlation with Explant Pathology
1Vanderbilt University Medical Center, Nashville, TN, 2Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, 3Thoracic Surgery
Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, 4GI and Hepatology, Vanderbilt University Medical Center, Nashville, TN, 5Vanderbilt Medical Center, Nashville, TN
Meeting: 2022 American Transplant Congress
Abstract number: 425
Keywords: Donation, Heart transplant patients, Histology, Liver transplantation
Topic: Clinical Science » Liver » 55 - Liver: Recipient Selection
Session Information
Session Name: Recipient Selection
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 7, 2022
Session Time: 3:30pm-5:00pm
Presentation Time: 4:40pm-4:50pm
Location: Hynes Room 312
*Purpose: Fontan-associated liver disease (FALD) is a well-described complication of Fontan physiology. More patients with failing Fontan are being evaluated for heart transplant and evidence-based guidelines on who benefits from combined heart-liver transplantation(CHLT) vs. heart alone are lacking. Liver biopsy is a well-established modality for liver disease staging among patients with other causes of cirrhosis but may be not reliable in FALD patients due to non-uniform fibrosis distribution. We compare peritransplant clinical and biopsy characteristics of FALD vs non-FALD patients who underwent a CHLT at our institution to determine reliability of pre-transplant evaluation in relation to explant pathology.
*Methods: 15 consecutive patients undergoing CHLT at our center were reviewed (January 1 2017- November 1 2021). Pre transplant clinical, radiographic, pathology data were collected and correlated with explant pathology. Liver pathology slides were reviewed by two pathologists, and scored both according to Metavir system and congestive hepatic fibrosis score (CHFS).
*Results: We identified 10 patients with FALD (median age 36, range 26-51), and 5 with non-FALD (median age 50; range 37-64): congestive hepatopathy(n=2), HCV(n=1), HCV/EtOH(n=1), hemochromatosis(n=1). A total of 4 patients died, 3 in FALD and 1 in non-FALD groups. Ten patients had cirrhosis on explant, 5 had F3 and 6 had findings of both F3 and F4 stages throughout explant liver. Seven patient (5 FALD and 2 non-FALD) had pretransplant liver biopsy slides available for review. When fibrosis was scored both according to the Metavir and CHFS system, a 1:1 correlation was observed. Pretransplant liver biopsy underestimated explant pathology (by 1 stage) in 5 out of 7 patients.
*Conclusions: In our series of CHLT recipients, Metavir and CHFS scoring system staged liver fibrosis similarly; pretransplant liver biopsy in our series tends to underestimate explant pathology regardless of etiology of liver disease. Traditional liver disease staging tools may not be reliable in this patient population.
| Age at Tx | Indication | Pre-Tx Pathology
Metavir
|
Pre-Tx Pathology CHFS | Explant Pathology Metavir | Explant Pathology CHFS |
| 35 | FALD | F3 | 3 | F3/F4 | 3/4 |
| 30 | FALD | F3 | 3 | F3 | 3 |
| 38 | FALD | F2 | 2A | F3 | 3 |
| 41 | FALD | F3/F4 | 3/4 | F3/F4 | 3/4 |
| 59 | FALD | F4 | 4 | F3/F4 | 3/4 |
| 50 | Non-FALD | F3 | 3 | F3/F4 | 3/4 |
| 37 | Non-FALD | F2 | 2 | F3/4 | 3/4 |
To cite this abstract in AMA style:
Shingina A, Menachem JN, Brown S, Ziogas IA, Wu WK, Izzy MJ, Liang J, Washington K, Alexopoulos S. Pre-Transplant Evaluation of Patients Undergoing Combined Heart-Liver Transplantation and Correlation with Explant Pathology [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-transplant-evaluation-of-patients-undergoing-combined-heart-liver-transplantation-and-correlation-with-explant-pathology/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress