*Purpose: Patients undergoing workup for Orthotopic Heart Transplant (OHT) undergo multi-organ evaluation for risk stratification. While cirrhosis is a known predictor of poor outcomes in this population, there is limited evidence regarding the impact of varying degrees of fibrosis. These patients undergo invasive liver biopsy to identify their pathology. We aimed to assess the association of baseline hepatic fibrosis severity from biopsy with clinical outcomes in waitlisted heart transplant patients.

*Methods: Twenty-two patients listed for transplant underwent liver biopsy between 2008-2019. Patients with absent or sinusoidal fibrosis (grade 1) were classified as low-risk, while central, bridging and portal fibrosis (grades 2-3) were classified as high-risk. Cirrhotic patients were excluded.

*Results: Among the 12 low-risk patients, 6 underwent OHT compared to the 7 of 10 high-risk patients. Congestive hepatopathy was the primary etiology of liver fibrosis in 70% of the patients. At time of listing, mean Model for End-Stage Liver Disease Excluding INR (MELD-XI), due to warfarin use, was 14 and 13 in low- and high-risk patients, respectively. We observed no significant difference in two-year survival and clinical outcomes of listed patients when stratified by degree of hepatic fibrosis (Figure).

*Conclusions: There was no significant difference observed in relevant clinical outcomes and two-year survival among patients with low- or high-risk biopsies. In the absence of clear cirrhosis on lab work and imaging findings, these results may suggest a lack of significant benefit of liver biopsy in patients as part of the workup for heart transplant candidacy. Future studies should be conducted with larger data populations for ongoing analysis.

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