Child-Turcotte-Pugh Class at Transplantation Predicts Mortality after Heart Transplantation Following Left Ventricular Assist Device Placement
1Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, 2Gastroenterology, Mayo Clinic, Rochester, MN
Meeting: 2020 American Transplant Congress
Abstract number: C-277
Keywords: Liver, Liver cirrhosis, Outcome, Risk factors
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session C: Heart and VADs: All Topics
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The primary aim of this study is to assess whether Child-Turcotte-Pugh (CTP) class is associated with mortality in end-stage heart disease patients undergoing left ventricular assist device (LVAD) as bridge to heart transplantation (HT) (BTT).
*Methods: Electronic medical records of patients undergoing LVAD as BTT from 2009-2018 at the Mount Sinai Hospital were retrospectively analyzed. The primary outcome was post-HT mortality associated with CTP at time of HT. Secondary outcomes were association between overall mortality and CTP at LVAD insertion, and overall mortality with change in CTP after LVAD.
*Results: 173 patients were included, of which 134 underwent HT and 16 remain waitlisted. There were 44 deaths (23 waitlist, 21 after HT). 16 had underlying primary liver disease. Median age at LVAD was 56; mean follow-up time from LVAD to last visit was 3.5 years. Univariate cox regressions of CTP at HT showed a lower risk of post-HT mortality in CTP-A compared to CTP-BC (p=0.02, HR 0.34, 95% CI 0.14-0.82). When change in CTP after LVAD was examined, improvement from CTP-BC to CTP-A after LVAD had a significant protective effect against overall mortality (p<0.01, HR 0.23) (Figure) and waitlist mortality (p=0.03, HR=0.17, 95% CI= 0.04-0.80) with a trend toward significance for post-HT mortality benefit (p=0.06, HR=0.34, 95% CI 0.11-1.07). Paired T-tests of albumin and INR pre-/post-LVAD showed significant increases in levels (mean delta albumin= +0.61, p<0.01; mean delta INR= +0.56, p<0.01), while total bilirubin (TB) fell (mean delta= -0.59, p<0.01). Mean albumin at HT was lower in patients who died after HT (3.5 vs. 3.9, p<0.01).
*Conclusions: Among patients undergoing LVAD as BTT, CTP-A (vs. CTP-BC) is associated with reduced post-HT mortality. Further, improvement in CTP class post-LVAD among CTP-BC patients is associated with improved waitlist and overall survival, with a trend toward improved post-HT survival. Higher pre-HT albumin, a marker of liver synthetic function, may contribute to this finding. CTP class may be useful for liver-related risk stratification among patients undergoing HT evaluation.
| Number | % Total | |
| White ethnicity | 70 | 40% |
| Non-white ethnicity | 103 | 60% |
| Ischemic heart disease | 60 | 35% |
| Nonischemic heart disease | 113 | 65& |
| Hepatitis C Virus | 4 | 2% |
| Hepatitis B Virus | 6 | 3% |
| Other biopsy-proven primary liver disease | 6 | 3% |
To cite this abstract in AMA style:
Leven E, Kurdi AT, Pinney S, Schiano T, Crismale J. Child-Turcotte-Pugh Class at Transplantation Predicts Mortality after Heart Transplantation Following Left Ventricular Assist Device Placement [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/child-turcotte-pugh-class-at-transplantation-predicts-mortality-after-heart-transplantation-following-left-ventricular-assist-device-placement/. Accessed March 4, 2021.« Back to 2020 American Transplant Congress