Heart Transplantation Outcomes in Liver Cirrhosis: Influence of Ascites on Post-Transplantation Survival

Purpose Liver cirrhosis has been implicated in poor outcome after heart transplant. However, no distinct correlation has been known between pre-existing ascites and outcomes after heart transplantation. Methods From 1994 to 2018, 170 patients with advanced heart failure underwent heart transplantation. Abdominal sonography or CT was performed to assess ascites in 163 patients preoperatively. Among them, 49 patients (30.0%) had visualized ascites and enrolled in this study. We divided them into two groups [group A; mild ascites (n=35), B; moderate to massive ascites (n=14)] and compared the clinical outcomes. Results In this cohort (19 men and 30 women, mean age 41, range 12-68 years), the causes of heart failure were dilated cardiomyopathy (DCMP) in 29 patients (59.2%), ischemic CMP in 7 patients (14.3%), valvular disease in 7 patients (14.3%) and congenital heart disease in 6 patients (12.4%). There was no difference in baseline characteristics between groups, except preoperative ascites points (group A: 1.20±0.19 vs. group B: 2.29 ± 0.46; p=0.001). Calculating scoring systems related to liver disease, MELD score was 11.73 vs. 12.4 (p=0.517), MELD-XI score was 12.9 vs. 13.7 (p=0.205) and Child-pugh score was 6.2 vs. 7.3 (p=0.843). The mean duration of follow up was 38.8 ± 42.5 months. After transplantation, ascites points were significant improved in group B (2.29 ± 0.46 to 1.74 ± 0.81, p=0.003). The 1, 2, 5 and 10-year survival rates were 82.8% vs 74.3%, 78.4% vs 74.3%, 74.6% vs 74.3% and 74.6% vs 74.3%, respectively, and the survival rates was significant lower until 2 years in group B than A (p=0.035). However, there was no difference after 2 years (p=0.793). Cox-regression analysis showed a moderate to massive ascites was associated with an increased risk of all-cause death after transplantation (p Conclusion Liver cirrhosis with moderate to severe ascites affected worse overall survival until 2 years after heart transplantation.