title: Hepatic and renal function with successful long-term support on a continuous flow left ventricular assist device.
abstract: BACKGROUND
  Data regarding the long-term clinical effects of a continuous flow left ventricular assist device (CF-LVAD) on hepato-renal function is limited. Hence our aim was to assess changes in hepato-renal function over a one-year period in patients supported on a CF-LVAD.
  
  
  METHODS
  During the study period 126 patients underwent CF-LVAD implant. Changes in hepato-renal laboratory parameters were studied in 61/126 patients successfully supported on a CF-LVAD for period of one year. A separate cohort of a high-risk group (HCrB) of patients (56/126) with a serum creat>1.9 mg/dL (168 μmol/L) (75th percentile) or a serum bil>1.5 mg/dL (25.65 μmol/L) (75th percentile) was created. Changes in serum creatinine and bilirubin were analysed at regular intervals for this group along with the need for renal replacement therapy.
  
  
  RESULTS
  Baseline creatinine and blood urea nitrogen (BUN) for the entire cohort was 1.4[1.2,1.9 mg/dL] [123.7(106,168) μmol/L) and 27[20,39.5 mg/dL] [9.6(7.1,14.1) mmol/L] respectively. After an initial reduction at the end of one month [1(0.8,1.2) mg/dL; 88(70,105) μmol/L] (p<0.0001), a gradual increase was noted over the study period to reach (1.25[1.1,1.5] mg/dL; 106(97.2,132.6) μmol/L] (p=0.0003). The serum bilirubin normalised from a [1(0.7,1.55) mg/dL] [17(18.8,25.7) μmol/L) to 0.9(0.6,1.2)mg/dL [15.4(10.2,20.5) μmol/L] (p=0.0005) and continued to decline over one year. Improvement in the synthetic function of the liver was demonstrated by a rise in the serum albumin levels to reach 4.3[4.1,4.5] [43(41,45) gm/L] at the end of one year (p<0.0001). The baseline serum creatinine and bilirubin for the high-risk cohort (HCrB) was 1.9(1.3,2.4) mg/dL [168(115,212) μmol/L] and 1.7(1.00,2.4) mg/dL [29(17.1,68.4) μmol/L] respectively. The high-risk cohort (HCrB) demonstrated a trend towards higher 30-day mortality (p=0.06). While the need for temporary renal replacement therapy was higher in this cohort (16% vs. 4%; p=0.03), only 3% need it permanently. A significant reduction in creatinine was apparent at the end of one month [1.1(0.8,1.4) mg/dL; 97(70.7,123.7) μmol/L] (p<0.0001) and then remained stable at [1.3(1.1,1.5) mg/dL; 115(97,132.6) μmol/L]. Bilirubin demonstrated a 30% decline over one month and then remained low at [0.7(0.5,0.8) mg/dL; 62(44,70) μmol/L] p=0.0005 compared to the pre-operative baseline.
  
  
  CONCLUSIONS
  Hepato-renal function demonstrates early improvement and then remains stable in the majority of patients on continuous flow left ventricular assist device support for one year. High-risk patients demonstrate a higher 30-day mortality and temporary need for renal replacement therapy. Yet even in this cohort, improvement is present over a period of one year on the device, with a minimal need for permanent haemodialysis.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Vikas
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, United States.
authors.forename: Tal
authors.initials: T
authors.lastname: Hasin
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, United States.
authors.forename: John
authors.initials: J
authors.lastname: Dillon
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Ishan K
authors.initials: IK
authors.lastname: Shah
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Lucian A
authors.initials: LA
authors.lastname: Durham
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, United States. Electronic address: park.soon@mayo.edu.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D006353:Heart-Assist Devices; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007677:Kidney Function Tests; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D014508:Urea / Q000097:blood*
chemical_list: D014508:Urea; D003404:Creatinine; D001663:Bilirubin
keywords: Congestive heart failure; Hemodialysis; Hepatic function; Left ventricular assist device; Renal function