Clinicopathologic findings in native liver biopsies after heart transplantation and total artificial heart implantation

Liver biopsy is common before heart transplantation to assess for advanced fibrosis that could require combined heart-liver transplantation. While congestive hepatopathy is common in these biopsies, little is known about what happens in the native liver after heart transplantation. In this study, 1300 adult heart explants were identified at a single institution, 38 of which had subsequent native liver biopsies (2.9 %), including 31 after orthotopic heart transplantation (OHT) and 7 after total artificial heart (TAH) implantation. Presentation was variable, but similar overall between post-OHT and post-TAH patients, with elevated liver function tests being the most common indication for liver biopsy (15/38; 39.5 %), and AST levels being significantly higher in post-TAH patients than post-OHT patients (mean: 172.4 vs. 59.8 U/L, respectively; p = 0.0077). A wide variety of histological patterns was seen, but the most common was a vascular outflow impairment pattern in 11/38 (28.9 %) patients. Fibrosis was predominantly mild (23/38; 60.5 %), with advanced fibrosis in 5 (13.2 %), no fibrosis in 6 (15.8 %), and insufficient parenchyma for evaluation in 4 (10.5 %). Fewer than half of patients with vascular outflow impairment pattern had a clinical diagnosis of heart failure, suggesting alternative etiologies of vascular injury in post-OHT/TAH patients.