Heart transplantation in patients with liver cirrhosis
Heart transplantation in patients with liver cirrhosis
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DOI：
10.1016/j.ejcts.2008.05.003
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发表时间：
2008-08-01
影响因子：
3.4
通讯作者：
Chu, Shu-Hsun
中科院分区：
文献类型：
--
作者：
Hsu, Ron-Bin;Chang, Chung-I;Chu, Shu-Hsun
目的：肝硬化是心脏移植的禁忌证。然而，肝硬化患者心脏移植的临床结果尚未报道。在这里，我们试图评估心脏移植患者的临床结果。方法：采用回顾性病历分析法收集资料。移植时有肝硬化的患者被包括在内。结果：1987年至2007年，12例肝硬化患者在作者所在医院接受了心脏移植。肝硬化的诊断是基于术前腹部超音波检查五例，尸检五例，剖腹探查两例。心力衰竭的原因是扩张型心肌病4例，冠状动脉疾病3例，先天性心脏病3例，心脏瓣膜病2例。肝硬化的原因是酒精中毒2例，心脏性7例，3例不明。Child分级为A级3例，B级5例，C级4例。总体而言，住院死亡率为50%，9名患者（75%）发生了严重的住院并发症。非心肌病诊断、既往胸骨切开术和大量腹水患者的住院死亡率较高。中位随访时间为33.5个月。没有晚期死亡。4例患者发生移植后晚期并发症，无肝功能障碍事件。所有幸存者在门诊随访时均为儿童A级。结论：虽然有较高的死亡率和发病率，终末期心力衰竭和肝硬化患者可以考虑心脏移植与仔细的情况下选择。(C)2008年欧洲胸外科协会。Elsevier B.V.出版，保留所有权利。
Objective: Liver cirrhosis is considered to be a contraindication to heart transplantation. However, the clinical outcome of heart transplantation in patients with liver cirrhosis has not been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in cirrhotic patients. Methods: Data were collected by retrospective chart review. Patients with liver cirrhosis at the time of transplantation were included. Results: Between 1987 and 2007, 12 patients with liver cirrhosis underwent heart transplantation at the authors' hospital. Diagnosis of liver cirrhosis was based on preoperative abdominal sonography in five, autopsy in five, and laparotomy in two patients. Causes of heart failure were dilated cardiomyopathy in four, coronary artery disease in three, congenital heart disease in three and valvular heart disease in two patients. Causes of liver cirrhosis were alcoholism in two, cardiac in seven, and unknown in three patients. The Child classification was class A in three, class B in five and class C in four patients. Overall, the hospital mortality rate was 50% and major in-hospital complications occurred in nine patients (75%). Patients with non-cardiomyopathy diagnosis, previous sternotomy, and massive ascites had a high hospital mortality rate. The median follow-up duration was 33.5 months. There was no late death. Late post-transplant complications occurred in four patients and there was no event of liver dysfunction. All survivors were in Child class A at outpatient follow-up. Conclusions: Although there was high mortality and morbidity, patients with end-stage heart failure and liver cirrhosis can be considered for heart transplantation with careful case selection. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.