title: Cardiac hepatopathy before and after heart transplantation.
abstract: Chronic cardiac hepatopathy is a common entity in patients evaluated for heart transplantation (HTX). Hepatic injury is caused by severe heart failure resulting from prolonged recurrent congestion and/or impaired arterial perfusion. No data are available on the reversibility of cardiac hepatopathy in patients undergoing HTX. Data of 56 consecutive adult patients undergoing HTX during 2000-02 at the University Hospital of Innsbruck were analysed retrospectively. The following parameters were evaluated at the time of listing and 3, 6 and 12 months after HTX. Plasma levels of gamma-glutamyl transferase (gamma-GT), alkaline phosphatase (AP), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and total plasma protein. When listed for HTX, only 12% of all patients analysed had physiological values throughout the seven laboratory parameters assessed. Elevated levels of gamma-GT, AP, bilirubin, AST, ALT, LDH and total plasma protein were detected in 66.6%, 29%, 50%, 16.7%, 10%, 40% and 18% of all patients respectively. Accordingly, median plasma levels of gamma-GT, bilirubin and LDH were elevated, whereas the mean plasma level of AP was at the upper normal range. In contrast, median plasma level of AST and mean plasma levels of ALT and total plasma protein were within the normal range: gamma-GT (median, 109.0; range, 634.0 U/l; n = 36), AP (mean, 120.2 +/- 78.9 U/l; n = 29), bilirubin (median, 1.3; range, 16.1 mg/dl; n = 32), LDH (median, 226.0; range, 2355.0 U/l; n = 33), AST (median, 29.0; range, 145.0 U/l; n = 36), ALT (mean, 28.3 +/- 20.8 U/l; n = 36) and total plasma protein (mean, 7.2 +/- 1.1 g/dl; n = 25). Within 3 months after HTX, elevated parameters except LDH significantly ameliorated: gamma-GT (median, 59.0; range, 1160.0 U/l; P = 0.011), AP (92.2 +/- 75.2 U/l; P = 0.016), bilirubin (median, 0.9; range, 8.1 mg/dl; P = 0.004), LDH slightly increased (median, 281.0; range, 543.0 U/l; P = 0.039), but there was a delayed improvement of this parameter after 6 and 12 months post-HTX. End-stage heart failure is characterized by a cholestatic liver enzyme profile with elevated plasma levels of gamma-GT and bilirubin. These parameters significantly improve within 3 months after HTX. Therefore, chronic cardiac hepatopathy seems to be a benign, potentially reversible disease.
authors.affiliation: Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria. wolfgang.dichtl@uibk.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dichtl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Karin M
authors.initials: KM
authors.lastname: Dunst
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Grander
authors.forename: Hannes F
authors.initials: HF
authors.lastname: Alber
authors.forename: Matthias
authors.initials: M
authors.lastname: Frick
authors.forename: Herwig
authors.initials: H
authors.lastname: Antretter
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pölzl
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002779:Cholestasis / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D017093:Liver Failure / Q000209:etiology*; D008297:Male; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D007770:L-Lactate Dehydrogenase; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase