Fontan‐Associated Liver Disease: Spectrum of Disease in Children and Adolescents

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Anna F. Lee¹  Kevin C. Harris²  Christine Voss²  Steven L. Rathgeber²  Nicole M. Hemphill²  Orlee R. Guttman³  Richard A. Schreiber³ 

[1] Department of Pathology and Laboratory Medicine British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada;Division of Cardiology Department of Pediatrics British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada;Division of Gastroenterology Department of Pediatrics British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada;

关键词: congenital heart disease;    Fontan procedure;    liver;   

DOI  :  10.1161/JAHA.119.012529

来源: DOAJ

【 摘 要 】

Background Information is evolving on liver disease in pediatric patients with Fontan physiology. The purpose of this investigation is to evaluate the spectrum of liver disease in a pediatric population of patients with Fontan physiology and evaluate transient elastography (TE) as a noninvasive marker of liver disease. Methods and Results We prospectively enrolled all children with Fontan physiology. All patients underwent comprehensive liver evaluation including liver enzymes (alanine aminotransferase, aspartate aminotransferase, gamma‐glutamyl transferase, alkaline phosphatase), aspartate transaminase to platelet ratio index, albumin, bilirubin, international normalized ratio, complete blood cell count, abdominal ultrasound, and TE. Transjugular liver biopsies and hemodynamic measurements were performed in a subset of patients. A total of 76 children (median, 11.7; interquartile range, 8.4–14.8 [56% male]) were evaluated, with 17 having a transjugular liver biopsy (median 14.8 years; interquartile range, 14.3–17.4). All biopsies showed pathological changes. The severity of liver pathology did not correlate with TE. There was a positive correlation between TE and time since Fontan (R=0.42, P<0.01), aspartate transaminase to platelet ratio index (R=0.29, P=0.02), aspartate transaminase (R=−0.42, P<0.01), and platelets (R=−0.42, P<0.01). Splenomegaly on abdominal ultrasound was correlated with TE (z=−2.2, P=0.03), low platelet count (z=1.9, P=0.05), low aspartate transaminase (z=1.9, P=0.02), and low alkaline phosphatase (z=2.4, P=0.02). Conclusions Liver disease was ubiquitous in our cohort of pediatric patients with Fontan Physiology. Given the correlation between TE and time from Fontan, TE shows potential as a prospective marker of liver pathology. However, individual measurements with TE do not correlate with the severity of pathology. Given the prevalence of liver disease in this population, protective measures of liver health as well as routine liver health surveillance should be implemented with consideration for hepatology consultation and biopsy in the event of abnormal liver biochemical markers or imaging.

【 授权许可】

Unknown