Background: Chronic heart failure causes chronic passive congestion of liver that can progress to advanced fibrosis. Liver biopsy is performed for assessment of fibrosis to risk stratify patients for isolated heart or dual heart and liver transplantation, or ventricular assist device (VAD) implantation. Aim of study was to correlate cardiac hemodynamic parameters with hepatic fibrosis and assess changes after VAD or cardiac transplantation.

Design: Pre-transplant or pre-VAD liver biopsies were assessed for features of congestive hepatopathy. Hepatic fibrosis score was assessed as 0-4: 0- no fibrosis, 1- perisinusoidal fibrosis, 2- perisinusoidal and portal/periportal fibrosis, 3- bridging fibrosis, 4- cirrhosis. Electronic chart review was done for cardiac hemodynamic data within 3 months of the biopsy. Patients with concomitant viral or alcoholic hepatitis, or metabolic liver disease were excluded.

Results: 76 patients of congestive hepatopathy were identified, of which 38 patients met the selection criteria for this study. Male:female;36:2. Hepatic fibrosis was noted in 29 patients (76%). No fibrosis was seen in 9(24%) patients. Patients with advanced fibrosis had significantly higher right atrial pressure (17.55± 8.3 vs10.22+7.4, P< 0.0041) and pulmonary artery pressure (45.57±7.4 vs29.0+10.6, P< 0.007), compared to no fibrosis or early fibrosis. Eleven of 38 patients had subsequent liver specimen available for review, post-transplant or VAD, as liver biopsies (n=8), autopsy (n=2) and liver explant (n=1). The time to second liver specimen ranged from 2 months to 2 years. Cardiac hemodynamic parameters significantly improved after transplant or VAD. The hepatic fibrosis score decreased in 4 patients, remained the same in 3 patients, and increased in 1 patient despite cardiac hemodynamic improvement.

Conclusions: Hepatic fibrosis is common in the setting of congestive hepatopathy and it correlates with cardiac hemodynamics. This may regress after cardiac hemodynamic improvement or remain same. Long term follow up is required to assess the histopathogical improvement after VAD implantation.

CITATION INFORMATION: Dhingra S., Segura A., Cortes-Santiago N., Schwartz M., Mittal S., Jalal P., Sood G. Congestive Hepatic Fibrosis: Correlation with Cardiac Hemodynamics and Changes after VAD or Cardiac Transplant Am J Transplant. 2017;17 (suppl 3).

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