A Novel Fibrosis Staging System for Cardiogenic Liver Disease and Relationship with Clinical, Biochemical, and Heart Physiologic Parameters: Development of a Common Language for Liver Transplant Decisions
Melissa A Grilliot, Javier Rojas, Erica F Clayton, Emma E Furth. University of Pennsylvania, Philadelphia, PA
Background: Standard fibrosis staging schemes, which drive clinical decisions, are well established for many chronic liver diseases, however, no such system exists for fibrosis secondary to mechanical vascular etiologies seen in heart disease. For patients undergoing heart transplantation, we are often faced with assessing the need for a joint liver transplantation; unlike other liver diseases, no standard parameters exist for this liver transplant decision. We propose a novel liver fibrosis scoring system specific for outflow obstruction etiologies and determined its relationship with clinical, biochemical, and physiologic parameters and concordance between biopsy and liver explants.
Design: Patients with a diagnosis of changes consistent with venous outflow obstruction were selected for study and those with other patterns of liver injury not due to cardiac causes were excluded. The extent of fibrosis (Masson's Trichrome) was scored: 1. centrovenular (CV) on a scale of 0 (none) to 5 (central to portal bridging), 2. percent (%) space of Disse fibrosis (SOD) and 3. percent surface area of fibrosis (SAF). Cardiac ejection fraction, corrected and free hepatic sinusoidal pressures, liver function tests, serum albumin and total protein were correlated with fibrosis scores.
Results: We evaluated 46 patients (median age 32 years [range 22-78]; 29 men, 17 women; 8 with congenital heart disease), 14 of whom underwent joint heart-liver transplantation. 43 patients had liver biopsies, including 8 who had subsequent explants. The median + standard deviation of fibrosis scores are as follows: 1. CV 3+1.6; 2. SOD 90%+33%; 3. SAF 20%+15.6%. There was a strong linear relationship with percent SAF and CV score [SAF=8.3xCV+1.4, R=0.81] but no correlation with any of the biochemical or physiologic parameters (R<0.15). Biopsies and liver explants had concordance of scores.
Conclusions: We propose the percent surface area of fibrosis be used as a single metric for evaluation of liver disease secondary to heart disease. This metric is amenable to future computer image analysis and can serve as a common language to develop decision models for joint heart and liver transplantation. That the fibrosis scores are independent of any clinical, biochemical and physiologic parameters attests to the need for liver biopsy in developing models for clinical decision making in the setting of heart disease.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 260, Monday Morning