Regression of Cardiac Cirrhosis and Survival After Heart Transplantation

Abstract

Introduction: There is limited literature whether patients with end-stage heart failure and cardiac cirrhosis should undergo heart transplantation. Many patients are excluded from heart transplantation due to underlying cardiac cirrhosis. Regression of cirrhosis has been shown in a few case studies, however, outcomes of patients with cardiac cirrhosis who underwent heart transplantation is unknown. Aims: To determine short and long-term survival and examine the possibility for regression of cardiac cirrhosis after heart transplantation. Methods: We identified all adult patients with clinical diagnosis of cardiac cirrhosis who underwent heart transplantation (n=43) at our institution between April 1991 and January 2009. Cirrhosis was defined on the basis of histological confirmation or evidence of portal hypertension and nodularity on imaging. Patients with any form of primary liver pathology were excluded (n=5). Multivariate logistic regression analysis was used to identify factors independently associated with mortality after cardiac transplantation. Outcomes were analyzed using Kaplan-Meier method. Mortality data was collected from our electronic health records and confirmed using the social security death index. Results: In our study cohort of 38 patients (median age, 59.0 ±15.7 years; males, 84.2%; Caucasian, 76.3%, pre-transplant median MELD, 12.50 ± 5.47; median follow up, 40 months), 9 patients had clinical diagnosis substantiated by biopsy or imaging. Three patients with pre-transplant biopsy also underwent post-transplant biopsy. One patient with biopsy proven stage 4 fibrosis regressed to stage 2 after cardiac transplantation. Survival at 30 days, 1 year, and 5 years in our patient cohort were 92.11%, 81.49% and 69.27% respectively (Figure 1). Multivariate Cox regression analysis revealed that pre-transplant MELD, biopsy or image proven cirrhosis, did not predict all-cause mortality. Conclusion: Liver cirrhosis due to end stage heart failure is not a contraindication for heart transplantation as survival is comparable to nationwide estimates of patients without cirrhosis undergoing heart transplantation.