Background: Patients awaiting heart transplantation who have known liver disease from congestive hepatopathy are at increased risk for mortality post-transplantation. The evaluation of the liver in these patients is difficult as the liver scans and even the liver biopsy (Bx) may not be representative of the true pathology. We decided to assess our patients being evaluated for transplant with known congestive hepatopathy who had both liver scans by either ultrasound (US) or computerized tomography (CT) scans, and liver Bx. All patients underwent heart transplant and outcomes were assessed for patients with liver abnormalities.

Methods: Between Jan 2010 and Dec 2013 we evaluated 22 patients who had known congestive hepatopathy. Patients were divided into two groups: abnormal liver scan and mild fibrosis on liver bx, and abnormal liver scan and moderate to severe fibrosis on liver bx. Abnormal liver scans described nodular surface with coarse parenchyma. Outcomes included 3-year survival, freedom from cardiac allograft vasculopathy (CAV) as defined by stenosis ≥ 30% by angiography, freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), freedom from abnormal liver enzymes greater than 3 times normal.

Results: There was no significant difference for heart transplant 3-year survival, 3-year freedom from CAV and 3-year freedom from NF-MACE. However, there appear to be a strong trend towards poorer heart transplant survival in the abnormal scan and moderate to severe fibrosis group. There was no significant difference observed in abnormal liver enzyme levels (3x normal range) for all groups.

Conclusion: There appears to be a greater risk for reduced survival in patients with abnormal liver scans and moderate to severe fibrosis on liver bx. Further investigation with a larger population size is warranted.

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CITATION INFORMATION: Mohan R, Patel J, Kittleson M, Chang D, Aintablian T, Czer L, Esmailian F, Kobashigawa J. Liver Evaluation for Heart Transplantation: Which Is Better, Noninvasive Scans or Liver Biopsy? Am J Transplant. 2016;16 (suppl 3).

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