Hepatorenal dysfunction assessment with the Model for End-Stage Liver Disease Excluding INR score predicts worse survival after heart transplant in pediatric Fontan patients

Fontan physiology results in multiorgan dysfunction, most notably affecting the liver and kidney. We evaluated the utility of Model for End-Stage Liver Disease Excluding INR (MELD-XI) score, a score evaluating the function of both liver and kidney to identify Fontan patients at increased risk for mo...

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Published in:	The Journal of thoracic and cardiovascular surgery Vol. 163; no. 4; pp. 1462 - 1473.e12
Main Authors:	Amdani, Shahnawaz, Simpson, Kathleen E., Thrush, Phil, Shih, Renata, Simmonds, Jacob, Knecht, Ken, Mogul, Douglas B., Hurley, Kathleen, Koehl, Devin, Cantor, Ryan, Naftel, David, Kirklin, James K., Daly, Kevin P.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2022
Subjects:	congenital heart disease Fontan transplant outcomes Fontan-associated liver disease heart transplant MELD-XI post-transplant survival ventricular assist device eGFR MELD-XI PLE HR Fontan transplant outcomes HT ventricular assist device post-transplant survival PHTS MELD congenital heart disease VAD heart transplant CAV Fontan-associated liver disease CHD
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Summary:	Fontan physiology results in multiorgan dysfunction, most notably affecting the liver and kidney. We evaluated the utility of Model for End-Stage Liver Disease Excluding INR (MELD-XI) score, a score evaluating the function of both liver and kidney to identify Fontan patients at increased risk for morbidity and mortality post–heart transplant. The Pediatric Heart Transplant Society database was queried to identify Fontan patients listed for heart transplant between January 2005 and December 2018. MELD-XI scores were calculated at listing and heart transplant. A multivariable analysis was conducted to identify risk factors for post–heart transplant mortality. Demographic, clinical characteristics, and survival differences were evaluated and compared between the high and low MELD-XI score cohorts. The impact of changing MELD-XI scores during the waitlist period on post–heart transplant outcomes was also evaluated. Of 565 Fontan patients who underwent transplantation, 524 (93%) had calculable MELD-XI scores at the time of heart transplant: 421 calculable at listing and 392 calculable at listing and at heart transplant. On multivariable analysis, only MELD-XI score (squared) (hazard ratio, 1.007), history of protein-losing enteropathy (hazard ratio, 2.1), and ventricular assist device use at transplant (hazard ratio, 3.4) were risk factors for early phase post–heart transplant mortality. Patients with high MELD-XI scores at heart transplant had inferior survival post–heart transplant (P = .02); those in the high MELD-XI score cohort at wait listing and heart transplant tend to have the worst post–heart transplant survival; however, this was not significant (P = .42). The MELD-XI, an easily calculated score, serves as a valuable aid in identifying pediatric Fontan patients at increased risk for post–heart transplant mortality. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-5223 1097-685X
DOI:	10.1016/j.jtcvs.2021.02.014