title: Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction.
abstract: BACKGROUND
  The prevalence of heart failure (HF) is rising and the only corrective treatment is cardiac transplantation. Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. We hypothesized that hepatic dysfunction is associated with impaired clinical outcome after heart transplantation.
  
  
  METHODS
  Data of 617 adult patients (75% men, mean age 53 ± 12 years, mean BMI 25 ± 4, mean ejection fraction 19 ± 9%) undergoing orthotopic heart transplantation (OHT) were analyzed retrospectively. Deviation from institutional normal ranges was used to define abnormal liver function. Standard Model for End-stage Liver Disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) was created to eliminate the confounding effects of anti-coagulation.
  
  
  RESULTS
  Before OHT, AST, ALT and total bilirubin were elevated in 20%, 18% and 29% of the population, respectively. Total protein and albumin were decreased in 25% and 52% of the population, respectively. By 2 months post-transplantation, percentages of individuals with pathologic values decreased significantly, except for ALT, total protein and albumin, all of which took longer to normalize. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up.
  
  
  CONCLUSIONS
  In this large, single-center retrospective study, we demonstrated the dynamics of liver dysfunction after cardiac transplantation and that elevated MELD scores indicating impaired liver function are associated with poor clinical outcome after OHT. Thus, pre-operative liver dysfunction has a significant impact on survival of patients after cardiac transplantation.
authors.affiliation: Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Aalap
authors.initials: A
authors.lastname: Chokshi
authors.forename: Faisal H
authors.initials: FH
authors.lastname: Cheema
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Schaefle
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jiang
authors.forename: Elias
authors.initials: E
authors.lastname: Collado
authors.forename: Khurram
authors.initials: K
authors.lastname: Shahzad
authors.forename: Tuba
authors.initials: T
authors.lastname: Khawaja
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin