Schneider AS1*, Schettler A1, Markowski A1, Luettig B1, Schmitto JD2, Busch M1, Kempf T3, Strüber M4, Wedemeyer H1 and Fegbeutel C2
1Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
2Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Germany
3Department of Cardiology and Angiology, Hannover Medical School, Germany
4Cardiothoracic Transplant Surgery and Mechanical Circulatory Support, Newark Beth Israel Medical Center, USA
Serious complications after Left Ventricular-Assist-Device (LVAD) implantation include Liver
Dysfunction (LDF) and ultimately liver failure. Transaminases and bilirubin, which are commonly
used, are poor indicators of successful outcomes. We sought to identify better suited parameters
as successful outcome indicators in end-stage chronic heart failure patients with an LVADimplantation
This prospective controlled observational pilot study analyzed liver-function-tests in 58 patients
with end-stage chronic heart failure and an LVAD-implantation indication. The primary endpoint
was death from multiple organ failure (mostly liver dominated) within 30 days after LVADimplantation.
The secondary endpoint was risk-factor-evaluation for liver-associated death
preoperatively and on day 3 after LVAD-implantation.
We found significant differences at baseline between survivors and non-survivors in gamma-
Glutamyl Transferase (γ-GT), albumin as well as fibrosis and cirrhosis (p ≤ 0.039). Alkaline-
Phosphatase (AP) tended to be higher in non-survivors (p=0.058). We assigned these parameters
points and calculated patients’ LDF-risk. At least 3 abnormal parameters at baseline indicated a
50% death-risk after implantation. A high number of abnormal parameters suggested a high
liver-associated mortality-risk. After LVAD-implantation, the abnormal parameter constellation
differed from the preoperative one. On day 3, non-survivors had higher bilirubin and Glutamate-
Dehydrogenase (GLDH) levels and MELD-XI-scores than survivors (p ≤ 0.014). These are potential
markers for disease assessment. All but one patient with a high-risk LDF prognosis died, but patients
with low-risk survived LVAD-implantation.
Thus, combining preoperative ɣ-GT, AP, albumin, fibrosis, and cirrhosis and postoperative
bilirubin, GLDH, and MELD-XI scores is promising to identify patients with an increased risk for
severe liver-associated complications after LVAD-implantation.
Ventricular assist device; Liver dysfunction; Chronic HF; VAD; LVAD; Heart failure
Schneider AS, Schettler A, Markowski A, Luettig B, Schmitto JD, Busch M, et al. Combining Liver Function Parameters Identifies Patients with an Increased Risk for Complications after LVAD Implantation – A Pilot Study. J Gastroenterol Hepatol Endosc. 2022; 7(1): 1111..