Hepatic and cardiac iron overload among patients with end-stage liver disease referred for liver transplantation.
BACKGROUND
Iron overload is associated with fatal cardiovascular events following liver transplantation. Myocardial iron deposits were observed post-mortem in patients who died of cardiac events after transplantation at our institution. This observation prompted testing to exclude cardiac iron in subsequent transplant candidates.


OBJECTIVE
To assess the results of testing for iron overload in liver transplant candidates at our institution.


METHODS
Ferritin, TIBC, and serum iron were measured in cirrhotics referred for transplantation. Patients with transferrin saturation ≥50% and ferritin ≥250 ng/mL underwent liver biopsy graded for iron. Patients with 3-4+ hepatic iron deposits underwent HFE mutation analysis and endomyocardial biopsy with iron staining.


RESULTS
Eight hundred and fifty-six patients were evaluated for liver transplantation between January 1997 and March 2005. Two hundred and eighty-seven patients (34%) had transferrin saturation ≥50% and ferritin ≥250 ng/mL. Patients with markers of iron overload had more advanced liver disease than those with normal iron indices. One hundred and fifty-three patients underwent liver biopsy. Twenty-six patients (17%) had 3-4+ hepatic iron staining. One patient was a C282Y heterozygote. Endomyocardial biopsy was performed in 14 patients of whom nine had cardiac iron deposition.


CONCLUSIONS
Non-HFE-related cardiac iron overload can occur in advanced liver disease We therefore recommend screening for cardiac iron prior to liver transplantation.
O'Glasser
Avital Y
AY
Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health and Science University and the Portland Veterans Affairs Medical Center, Portland, OR 97219, USA.
Scott
David L
DL
Corless
Christopher L
CL
Zaman
Atif
A
Sasaki
Anna
A
Gopal
Deepak V
DV
Rayhill
Stephen C
SC
Orloff
Susan L
SL
Ham
John M
JM
Rabkin
John M
JM
Flora
Ken
K
Davies
Crispin H
CH
Broberg
Craig S
CS
Schwartz
Jonathan M
JM
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000097:blood / Q000209:etiology*; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000209:etiology* / Q000378:metabolism / Q000601:surgery; D005260:Female; D005293:Ferritins / Q000097:blood; D005838:Genotype; D006085:Graft Survival; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D019190:Iron Overload / Q000097:blood / Q000209:etiology*; D016031:Liver Transplantation; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D005293:Ferritins