Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction.
Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction.
复制标题
肝功能障碍和原位心脏移植后的生存：梅尔德评分系统的应用进行预测。
DOI：
10.1016/j.healun.2012.02.008
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发表时间：
2012-06
期刊：
影响因子：
--
通讯作者：
Schulze PC
中科院分区：
文献类型：
--
作者：
Chokshi A;Cheema FH;Schaefle KJ;Jiang J;Collado E;Shahzad K;Khawaja T;Farr M;Takayama H;Naka Y;Mancini DM;Schulze PC
心力衰竭（HF）的患病率正在上升，唯一的纠正治疗是心脏移植。晚期HF与充血性肝病以及肝脏的进行性功能和超微结构变化相关。我们假设肝功能障碍与心脏移植后临床结局受损相关。回顾性分析了617例成人原位心脏移植（OHT）患者（75%为男性，平均年龄53±12岁，平均BMI 25±4，平均射血分数19±9%）的资料。使用与机构正常范围的偏离来定义肝功能异常。计算终末期肝病标准模型（MELD）评分，并创建白蛋白替代INR的改良MELD评分（modMELD），以消除抗凝的混杂效应。在OHT之前，AST、ALT和总胆红素分别在20%、18%和29%的人群中升高。总蛋白和白蛋白分别在25%和52%的人群中下降。到移植后2个月，除了ALT、总蛋白和白蛋白外，具有病理学值的个体百分比显著降低，所有这些都需要更长的时间才能恢复正常。移植前MELD或modMELD评分较高的个体在移植后30天的预后较差，10年随访的长期生存率降低。在这项大型单中心回顾性研究中，我们证实了心脏移植后肝功能障碍的动力学，MELD评分升高表明肝功能受损与OHT后临床结局不良相关。因此，术前肝功能异常对心脏移植患者术后生存有重要影响。
The prevalence of heart failure (HF) is rising and the only corrective treatment is cardiac transplantation. Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. We hypothesized that hepatic dysfunction is associated with impaired clinical outcome after heart transplantation. Data of 617 adult patients (75% males, mean age of 53±12 years, mean BMI of 25±4 and mean ejection fraction of 19±9%) undergoing orthotopic heart transplantation (OHT) were analyzed retrospectively. Deviation from institutional normal ranges was used to define abnormal liver function. Standard model for end Stage liver disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) was created to eliminate the confounding effects of anticoagulation. Before OHT, AST, ALT and total bilirubin were elevated in 20%, 18% and 29% of the population, respectively. Total protein and albumin were decreased in 25 and 52% of the population, respectively. By 2 months post-transplantation, percentages of individuals with pathological values decreased significantly except ALT, total protein and albumin, all of which took longer to normalize. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up. In this large, single-center retrospective study, we demonstrate dynamics of liver dysfunction after cardiac transplantation and that elevated MELD scores indicating impaired liver function are associated with poor clinical outcome following OHT. Therefore, preoperative liver dysfunction has a significant impact on survival of patients after cardiac transplantation.
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影响因子：
3.4
作者：
Hsu, Ron-Bin;Chang, Chung-I;Chu, Shu-Hsun
通讯作者：
Chu, Shu-Hsun
影响因子：
3.1
作者：
Dichtl, W;Vogel, W;Pölzl, G
通讯作者：
Pölzl, G
影响因子：
2.6
作者：
Vasconcelos, Luiz Antônio Brito Arruda;Almeida, Eros Antônio de;Bachur, Luiz Felipe
通讯作者：
Bachur, Luiz Felipe
影响因子：
29.4
作者：
Wiesner, R;Edwards, E;Krom, R
通讯作者：
Krom, R
影响因子：
4.6
作者：
Ailawadi, Gorav;LaPar, Damien J.;Swenson, Brian R.;Siefert, Suzanne A.;Lau, Christine;Kern, John A.;Peeler, Benjamin B.;Littlewood, Keith E.;Kron, Irving L.
通讯作者：
Kron, Irving L.