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Ybarra AM, Khanna G, Turmelle YP, Stoll J, Castleberry CD, Scheel J, Ballweg JA, Ameduri R, Kimberling M, Makil E, Birnbaum BF, Exil V, Canter CE, Simpson KE. Heterogeneous outcomes of liver disease after heart transplantation for a failed Fontan procedure. Pediatr Transplant 2021; 25:e14094. [PMID: 34296503 DOI: 10.1111/petr.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/29/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Fontan-associated liver disease (FALD) uniformly affects patients with long-term Fontan physiology. The effect of isolated heart transplant (HT) on the course of FALD post-HT is not well understood. METHODS We evaluated serial liver imaging pre- and post-HT to assess liver changes over time in a single-center retrospective analysis of Fontan HT recipients who had pre- and ≥1-year post-HT liver imaging. Available patient demographic and clinical data were reviewed, including available liver biopsy results. RESULTS Serial liver imaging was available in 19 patients with a median age at HT of 12 years (range 3-23), the median age from Fontan to HT of 5.7 years (range 0.8-16), and the median time from imaging to follow up of 27 months (range 12-136 months). Pre-HT liver imaging was classified as follows: normal (n=1), congested (n=9), fibrotic (n=7), and cirrhotic (n=2). The majority of transplanted patients (15/19) had improvement in their post-HT liver imaging, including 13 patients with initially abnormal imaging pre-HT having normal liver imaging at follow-up. One patient had persistent cirrhosis at 26-month follow-up, one patient had unchanged fibrosis at 18-month follow-up, and one patient progressed from fibrosis pre-HT to cirrhosis post-HT at 136 months. No patients had overt isolated liver failure during pre- or post-HT follow-up. Liver biopsy did not consistently correlate with imaging findings. CONCLUSIONS Post-HT liver imaging evaluation in Fontan patients reveals heterogeneous liver outcomes. These results not only provide evidence for the improvement of FALD post-HT but also show the need for serial liver imaging follow-up post-HT.
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Affiliation(s)
- Aecha M Ybarra
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Geetika Khanna
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yumirle P Turmelle
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Janis Stoll
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Chesney D Castleberry
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Janet Scheel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean A Ballweg
- Department of Pediatrics, University of Nebraska, Omaha, NE, USA
| | - Rebecca Ameduri
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | | | - Elizabeth Makil
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Brian F Birnbaum
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vernat Exil
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Charles E Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathleen E Simpson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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