Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:31

Article

Yang, Jonathan A.²  Shulman, Brittney P.²  Takayama, Hiroo²  Naka, Yoshifumi²  Schulze, P. Christian¹ 

[1] Columbia Univ, Dept Med, Ctr Adv Cardiac Care, Med Ctr,Div Cardiol, New York, NY 10032 USA

[2] Columbia Univ, Dept Surg, Div Cardiothorac Surg, Med Ctr, New York, NY 10032 USA

关键词: transplantation;    ventricular assist device;    risk assessment;    cardiomyopathy;    liver dysfunction;   

DOI  :  10.1016/j.healun.2012.02.027

来源: Elsevier

【 摘 要 】

BACKGROUND: Liver dysfunction increases post-surgical morbidity and mortality. The Model of End-stage Liver Disease (MELD) estimates liver function but can be inaccurate in patients receiving oral anti-coagulation. We evaluated the effect of liver dysfunction on outcomes after ventricular assist device (VAD) implantation and the dynamic changes in liver dysfunction that occur during VAD support. METHODS: We retrospectively analyzed 255 patients (147 with pulsatile devices and 108 with continuous-flow devices) who received a long-term VAD between 2000 and 2010. Liver dysfunction was estimated by MELD and MELD-eXcluding INR (MELD-XI), with patients grouped by a score of >= 17 or < 17. Primary outcomes were on-VAD, after transplant, and overall survival. RESULTS: MELD and MELD-XI correlated highly (R >= 0.901, p < 0.0001) in patients not on oral anti-coagulation. Patients with MELD or MELD-XI < 17 had improved on-VAD and overall survival (p < 0.05) with a higher predictive power for MELD-XI. During VAD support, cholestasis initially worsened but eventually improved. Patients with pre-VAD liver dysfunction who survived to transplant had lower post-transplant survival (p = 0.0193). However, if MELD-XI normalized during VAD support, post-transplant survival improved and was similar to that of patients with low MELD-XI scores. CONCLUSIONS: MELD-XI is a viable alternative for assessing liver dysfunction in heart failure patients on oral anti-coagulation. Liver dysfunction is associated with worse survival. However, if MELD-XI improves during VAD support, post-transplant survival is similar to those without prior liver dysfunction, suggesting an important prognostic role. We also found evidence of a transient cholestatic state after LVAD implantation that deserves further examination. J Heart Lung Transplant 2012;31:601-10 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free