Furthermore, it is also

unclear whether liver disease, ev

Furthermore, it is also

unclear whether liver disease, even in the absence of cirrhosis, portends increased surgical mortality. These concerns warrant further investigation. In a single-center study, isolated cardiac transplantation after failure of Fontan procedures was associated with a 63% 1-year and 57% 5-year survival, which is approximately 12%-15% lower than the 1- and 5-year survival after isolated cardiac transplantation for other indications. Persons undergoing cardiac transplantation after Fontan had a lower survival (albeit not statistically significant) than persons undergoing a Glenn procedure.34 Deaths within 7 days of cardiac transplantation were caused by hemorrhage, sepsis, and multiorgan failure. Whether this website these were related to undiagnosed cardiac cirrhosis is unknown.34 The Model for End-Stage Liver Disease (MELD) score is used to both quantify the severity of liver disease as well as prioritize patients for organ allocation in the United States,

BIBW2992 order with a higher MELD score portending a poor outcome.35 It is possible that hepatic synthetic dysfunction among patients with CHD may not be accurately captured by mathematical modeling. For example, INR and albumin do not correlate with degree of histological severity in patients with CHD, and hence traditional models (e.g., Child–Turcotte–Pugh [CTP] or MELD) may be inadequate.11 This gap in knowledge needs to be studied, because decisions regarding transplantation (either liver transplantation < or combined heart-liver transplantation [CHLT]) may hinge on these scores.

In patients with cirrhosis of other etiologies undergoing open-heart surgery, the MELD score, CTP, American Society of Anesthesiologists class, and age are predictors of outcome.36 The mathematical risk model (http://www.mayoclinic.org/meld/mayomodel9.html) may be helpful in risk stratification in patients evaluated for repair of CHD defects. It should, however, be emphasized that derivation of the model did not include any patient that underwent surgery for CHD, and hence the above models are extrapolated MCE with caution to patients with CHD. Keeping these limitations in mind, Fig. 3 provides a guide for initial triage of patients with CHD and liver disease needing surgery. It represents our approach to taking care of patients with CHD and liver disease, though this has not been subject to prospective evaluation. It simply serves as a starting point for discussion in a multidisciplinary environment in evaluating the needs of the patients. Referral to a transplant center should be initiated once there are signs of decompensated liver disease. However, the effectiveness or safety of isolated LT in patients with significant CHD is limited in adults. Among children, LT has been successfully performed in selected candidates with CHD; approximately 18% of pediatric LT candidates have some form of CHD.

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