Liver and kidney function in patients undergoing mechanical circulatory support with Jarvik-7 artificial heart as a bridge to transplantation.

Changes in liver and kidney function were reviewed in 32 patients who received a Jarvik-7 total artificial heart (TAH) as a bridge to transplantation. Preoperatively, seven (22%) had significant isolated kidney dysfunction, five (15%) had isolated liver impairment, and 13 (41%) had combined disorder, affecting 25 (78%) of the 32 recipients. Immediately after TAH implantation, vigorous diuresis occurred, and biochemical indices improved in 17 patients: 71% of isolated kidney, 60% of isolated liver, and 38% of combined organ disorder were reversed irrespective of severity in preoperative dysfunction. In contrast, urine output remained poor, and biochemical indices continued to deteriorate in 15 patients regardless of preoperative status; as a result, kidney (28%), liver (17%), and combined organ failure (33%) accounted for a total of 78% of failure in this series. Although preoperative liver and kidney dysfunction were frequent and severe, they did not correlate with postoperative functional recovery and later transplantation. Recipient body size and initial postoperative urine output were found to be the variables discriminating patients with or without subsequent transplantation. Because liver/kidney failure remained as the leading cause of death, knowledge of the underlying cause of the organ failure would increase the success of TAH as a bridge to transplantation.