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Hepatic and renal end-organ damage in the Fontan circulation: A report from the Australian and New Zealand Fontan Registry.
- Source :
-
International journal of cardiology [Int J Cardiol] 2018 Dec 15; Vol. 273, pp. 100-107. Date of Electronic Publication: 2018 Jul 25. - Publication Year :
- 2018
-
Abstract
- Background: Hepatic and renal dysfunction have been observed in survivors of the Fontan procedure, however their incidence and associated factors remain poorly defined.<br />Methods: A total of 152 participants from a Registry of 1528 patients underwent abdominal ultrasound, transient elastography (FibroScan), serum fibrosis score (FibroTest), in vivo Tc-99m DTPA measurement of glomerular filtration rate (mGFR), and urine albumin-creatinine ratio (ACR).<br />Results: Mean age and time since Fontan were 19.8 ± 9.3 and 14.1 ± 7.6 years, respectively. Features suggestive of hepatic fibrosis were observed on ultrasound in 87/143 (61%) and no patient was diagnosed with hepatocellular carcinoma. FibroScan median kPa was ≥10 in 117/133 (88%), ≥15 in 75/133 (56%), and ≥20 in 41/133 (31%). Fifty-four patients (54/118, 46%) had a FibroTest score ≥0.49 (equivalent to ≥F2 fibrosis). FibroTest score correlated with FibroScan value (r = 0.24, p = 0.015) and ACR (r = 0.29, p = 0.002), and patients with ultrasound features of hepatic fibrosis had a higher FibroScan median kPa (19.5 vs 15.4, p = 0.002). Renal impairment was mild (mGFR 60-89 ml/min/1.73 m <superscript>2</superscript> ) in 46/131 (35%) and moderate (mGFR 30-59 ml/min/1.73 m <superscript>2</superscript> ) in 3/131 (2%). Microalbuminuria was detected in 52/139 participants (37%). By multivariable analysis, time since Fontan was associated with increased FibroScan median kPa (β = 0.89, 95% CI 0.54-1.25, p = 0.002) and decreased mGFR (β = -0.77, 95% CI -1.29-0.24, p = 0.005).<br />Conclusions: In the second decade after Fontan hepatic and renal structure and function are abnormal in a significant number of patients: close to 60% have ultrasonographic evidence of structural hepatic abnormalities, 46% have elevated serum hepatic fibrosis scores, and 57% have either reduced glomerular filtration rate or microalbuminuria. Hepatic and renal function should be monitored for potential impacts on outcomes after Fontan completion.<br /> (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Subjects :
- Adolescent
Adult
Australia epidemiology
Cross-Sectional Studies
Echocardiography trends
Female
Fontan Procedure adverse effects
Glomerular Filtration Rate physiology
Humans
Kidney physiology
Liver physiology
Male
New Zealand epidemiology
Young Adult
Fontan Procedure trends
Kidney diagnostic imaging
Liver diagnostic imaging
Registries
Research Report
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 273
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 30060970
- Full Text :
- https://doi.org/10.1016/j.ijcard.2018.07.118