S1237 Association of Liver Biopsy Pathology on Outcome of Patients Undergoing Heart Transplantation

Abstract

Introduction: Patients with advanced heart failure needing heart transplant (HT) commonly have some degree of liver dysfunction. Liver biopsies are the gold-standard for evaluating the severity of liver disease and are commonly performed prior to listing a patient for HT. However, there is limited data on the impact of liver fibrosis on outcomes for HT candidates. The objective of this study was to determine the relationship between liver fibrosis severity and mortality rates for patients on the HT waitlist and post-HT. Methods: A retrospective cohort study of adults listed for HT who underwent a liver biopsy for evaluation of liver fibrosis from 08/12/2004-02/16/2022 at a large heart transplant center was performed. Degree of fibrosis was categorized as either early (only fibrosis expansion of portal areas with or without short fibrous septa or no fibrosis) or advanced (evidence of portal-to-portal bridging or cirrhosis). Trend analysis was performed on clinical, laboratory and mortality data using Cox proportional hazard model, controlling for MELD-XI. At-risk period starts at the time of waitlist and extends into the post-transplant phase. The end of the follow-up period was defined as mortality on the waitlist, mortality post-HT, or administrative censoring at the end of the study period. Results: Of 42 patients with liver biopsies, 14 (33%) had advanced fibrosis, 28 (67%) had early fibrosis, and 2 (5%) patients had cirrhosis. There was no significant difference in the survival of patients with advanced fibrosis and early fibrosis over time (HR 1.37, CI 0.47- 3.98, p = 0.56). Fifteen waitlisted patients did not eventually receive transplants, and there was no significant difference in survival within group (HR 0.65, CI 0.18-2.32, p = 0.51); 9 of these 15 patients died on the waitlist. Twenty-seven patients did eventually receive transplants, and there was no significant difference in survival within this group (HR 1.00, CI 0.09-11.43, p = 1.00). (Figure) Conclusion: There was no significant difference in the survival rates between HT candidates with and without advanced fibrosis on the waitlist and post-HT, suggesting that patients on the transplant waitlist may not need liver biopsy for heart transplant workup. However, our sample population was derived from patients who were already on the transplant waitlist. Therefore, our results cannot be extrapolated to the general advanced heart failure population undergoing HT evaluation, many of whom are not waitlisted due to cirrhosis (Table). Table 1. - Predicted survival percentages for transplanted patients, non-transplanted patients, and both groups combined at 30 days, 1 year and 5 years with early liver fibrosis or advanced liver fibrosis from time of listing Transplanted Patients (% [CI]) Non-transplanted Patients (% [CI]) Transplanted and Non-transplanted Patients (% [CI]) Early Liver Fibrosis 30 Days 100 (0-100) 84.6 (66.0-100) 95.8 (90.0-100) 1 Year 96.2 (88.8-100) 53.5 (29.2-97.9) 84.5 (73.2-97.4) 5 Years 88.1 (74.6-100) 17.3 (3.6-84.0) 68.2 (52.4-88.9) Advanced Liver Fibrosis 30 Days 100 (0-100) 89.7 (75.7-100) 94.3 (86.1-100) 1 Year 96.2 (86.6-100) 66.6 (42.4-100) 79.3 (63.0-99.9) 5 Years 88.2 (67.4-100) 32.1 (9.8-100) 59.2 (37.6-93.1) CI = confidence interval. Figure 1.: (1) Survival curve of waitlisted patients with and without advanced liver fibrosis, including patients who received and did not receive transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis. (2). Survival curve of only those patients who did not receive transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis. (3) Survival curve of only those patients who received transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis.