Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2024 May;136(9-10):267-277. doi: 10.1007/s00508-023-02231-2. Epub 2023 Jun 28.
Heart failure (HF) might lead to increased hepatic venous pressure, thereby impairing hepatic blood outflow and subsequently inducing congestive hepatopathy. We aimed to evaluate prevalence of congestive hepatopathy in patients undergoing heart transplantation (HTX) as well as their post-transplant course.
Patients undergoing HTX from 2015-2020 at the Vienna General Hospital were included (n = 205). Congestive hepatopathy was defined by hepatic congestion on abdominal imaging and hepatic injury. Laboratory parameters, ascites severity, and clinical events were assessed and post-HTX outcomes evaluated.
At listing, 104 (54%) patients showed hepatic congestion, 97 (47%) hepatic injury, and 50 (26%) had ascites. Congestive hepatopathy was diagnosed in 60 (29%) patients, who showed more often ascites, lower serum sodium and cholinesterase activity, and higher hepatic injury markers. Mean albumin-bilirubin (ALBI)-score as well as (modified)-model for end-stage liver disease (MELD)-scores were higher in patients with congestive hepatopathy. Median levels of laboratory parameters/scores normalised after HTX, and ascites resolved in most patients with congestive hepatopathy (n = 48/56, 86%). The post-HTX (median follow-up 55.1 months) survival was 87% and liver-related events were rare (3%). Severe ascites, low cholinesterase, and MELD/MELD-XI were associated with ascites persistence/death 1‑year after HTX. Age, male sex, and severe ascites were the only independent predictors of post-HTX mortality. Both ALBI and MELD-scores were robust indicators of post-HTX survival when measured 4 weeks after HTX (ALBI log-rank test p < 0.001; MELD log-rank test p = 0.012).
Congestive hepatopathy and ascites were mostly reversible after HTX. Liver-related scores and ascites improve prognostication in patients after HTX.
心力衰竭（HF）可能导致肝静脉压升高，从而损害肝血流流出，并随后导致充血性肝病变。我们旨在评估接受心脏移植（HTX）的患者充血性肝病变的患病率以及他们的移植后病程。
纳入 2015 年至 2020 年在维也纳总医院接受 HTX 的患者（n=205）。通过腹部影像学和肝损伤来定义充血性肝病变。评估实验室参数、腹水严重程度和临床事件，并评估 HTX 后的结果。
在列入名单时，104 名（54%）患者出现肝充血，97 名（47%）出现肝损伤，50 名（26%）有腹水。60 名（29%）患者诊断为充血性肝病变，这些患者更常出现腹水，血清钠和胆碱酯酶活性较低，肝损伤标志物较高。充血性肝病变患者的平均白蛋白-胆红素（ALBI）评分和（改良）终末期肝病模型（MELD）评分更高。HTX 后，实验室参数/评分的中位数水平正常化，充血性肝病变患者的腹水大多得到解决（n=48/56，86%）。HTX 后的中位随访时间为 55.1 个月，存活率为 87%，肝脏相关事件很少（3%）。严重腹水、低胆碱酯酶和 MELD/MELD-XI 与 HTX 后 1 年腹水持续存在/死亡相关。年龄、男性和严重腹水是 HTX 后死亡的唯一独立预测因素。ALBI 和 MELD 评分在 HTX 后 4 周测量时是 HTX 后存活的可靠指标（ALBI 对数秩检验 p<0.001；MELD 对数秩检验 p=0.012）。
充血性肝病变和腹水在 HTX 后大多是可逆的。肝相关评分和腹水改善了 HTX 后患者的预后。
