Outcomes of patients with cardiac cirrhosis undergoing heart transplantation.

INTRODUCTION: Cardiac cirrhosis is common in patients with advanced heart failure and can limit heart transplant eligibility. We examined the outcomes of patients with cardiac cirrhosis following orthotopic heart transplantation. MATERIAL AND METHODS: A retrospective matched cohort study of adult patients with cirrhosis undergoing heart transplantation at an Australian hospital from 2009-2017 was performed. Cirrhosis was established by either a) histopathology or b) combination of radiological features of cirrhosis and portal hypertension plus clinical features of portal hypertension. Primary objectives were to assess mortality, perioperative and long-term complications. Matching was performed with non-cirrhotic patients undergoing heart transplantation in a 4:1 ratio. RESULTS: Five patients with biopsy proven cirrhosis or portal hypertension and 20 matched controls without cirrhosis were included. Additionally, 5 patients with clinical and radiological evidence of cirrhosis were assessed separately. The groups were well-matched for age at transplant, year of transplant, gender and co-morbidities. Mortality was more frequent but not significantly greater in the cirrhosis group with 2 deaths within 4 months of transplant compared to 1 death each in the no cirrhosis and suspected cirrhosis groups. (40%, 5%, 20% p=0.40). The median duration of intensive care unit stay was longer in the cirrhosis group compared to the suspected cirrhosis group (8 vs. 6 days, p=0.03) however there was no difference in total hospitalisation (p=0.56) or in median duration of admission (0.64) compared to the no cirrhosis group. CONCLUSIONS: These findings suggest that there is greater mortality associated with cases of definite cirrhosis compared to suspected or matched controls following orthotopic heart transplantation however statistical significance was not reached. Admission length and complication rates were similar compared to those without cirrhosis. Future studies are warranted to further evaluate mortality risk in a larger population.