Sokolski Mateusz, Ptak Jakub, Makieła Małgorzata, Szwajkowski Maciej, Waloszczyk Mateusz, Wiśniewski Kacper, Gontarczyk Joanna, Makowska Paulina, Krupka Dominik, Sitko Natalia, Cielecka Magdalena, Rakowski Mateusz, Bochenek Maciej, Przybylski Roman, Zakliczyński Michał
Institute of Heart Diseases, Jan Mikulicz Radecki University Hospital Wroclaw, 50556 Wroclaw, Poland.
Clinical Department of Heart Transplantation and Mechanical Circulatory Support, Department of Cardiac, Surgery and Heart Transplantation, Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, 50368 Wroclaw, Poland.
J Clin Med. 2025 Aug 22;14(17):5933. doi: 10.3390/jcm14175933.
: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. : Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. : The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4-16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4-17.7) vs. LVAD: 11.2 (7.3-14.9), = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure ( < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure ( < 0.002). : The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.
多器官功能衰竭（MOF）是晚期心力衰竭（HF）的常见并发症，对患者预后有重大影响。本研究旨在评估和比较原位心脏移植（HTx）和左心室辅助装置（LVAD）植入对MOF严重程度的影响，采用终末期肝病模型（不包括国际标准化比值，即MELD-XI）评分来衡量。
分析了HTx或LVAD植入术前1个月至术后1年的数据。MELD-XI评分使用胆红素和肌酐的平均值计算。在HTx组和LVAD组的术前和术后不同时间点对MELD-XI评分进行比较评估。
分析纳入了107例HTx患者和30例LVAD患者。所有患者术前1个月的MELD-XI评分中位数为11.7（9.4-16.7）。在3个月、6个月和12个月随访时，两组间MELD-XI评分无显著差异。然而，术后1个月观察到显著差异[HTx组：14.8（9.4-17.7）vs. LVAD组：11.2（7.3-14.9），P = 0.02]。在LVAD组，术后3个月的MELD-XI评分与术前1个月相比显著降低（P < 0.001），而在6个月和12个月随访时，评分与术前评分无差异。在HTx组，术后3个月、6个月和1年的MELD-XI评分与术前1个月相比均显著降低（P < 0.002）。
MELD-XI量表揭示了HTx和LVAD接受者之间不同的MOF轨迹。两种干预措施均能使肝肾功能早期改善，HTx患者有持续获益，突出了对器官功能的不同影响。
