Research Mentor Name
Research Mentor Email Address
Institution / Department
HFHS/ Gastroentrology & Heart and Vascular Institute (collaboration)
Level of Research
Purpose: Current guidelines for preoperative workup for an orthotopic liver transplant (OLT) recommend an echocardiogram that often rule-out patients with superimposed severe aortic stenosis as transplant candidates. The purpose of this study was to shed light on the potential of transcatheter aortic valve replacement (TAVR) as a bridging therapy for liver transplants in cirrhotic patients with severe AS.
Methods: A retrospective chart review was performed on 500 patient records that underwent liver transplantation at a single large tertiary care center between 2017 and mid-2021. Two cases of alcohol cirrhosis were further investigated due to the simultaneous diagnosis of severe AS.
Results: This study reports the details of the TAVR procedures that alleviated the AS and lead to reinstated eligibility for OLT for both cases. The 1-month, 3-month, 1-year post-liver transplant follow-ups showed no complications in the function of both patients’ prosthetic aortic valves. Noteworthy post-transplant complications unrelated to aortic valve function for Case#1 included a left lower quadrant hematoma that resolved on its own and a brief episode of alcoholic recidivism that was successfully treated with the help of transplant psychologists. Case #2 had a post-transplant recovery course complicated two days after OLT by MRI confirmed chronic ischemia and chronic microhemorrhages that lead to left-sided face drooping that improved within hours of onset.
Conclusion: Overall, these cases illustrate the effectiveness that TAVRs have on relieving the pre-transplantation risks of aortic stenosis in high-risk surgical aortic valve replacement patients.
Table 1. A comparison of echocardiogram parameters of the aortic valve for patients #1 and #2 before and after TAVR and after OLT. For patient #1 the Echo occurred 4 days after the OLT, and that for patient #2 was 2 months after due to unrelated complications in recovery.
Medicine and Health Sciences
Kaafarani, Mirna; Shamma, Omar; and Jafri, Syed-Mohammed, "Transcatheter aortic valve replacement restoring candidacy for liver transplant in cirrhotic patients" (2022). Medical Student Research Symposium. 170.