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Review
. 2021 Jan 27;3(2):100249.
doi: 10.1016/j.jhepr.2021.100249. eCollection 2021 Apr.

From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?

Anna Sessa  1   2 , Manon Allaire  1   3 , Pascal Lebray  1 , Mourad Medmoun  4 , Alberto Tiritilli  5 , Pierre Iaria  5 , Jean-François Cadranel  4
Affiliations
Review

From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?

Anna Sessa et al. JHEP Rep. .

Abstract

Heart failure and liver disease often coexist because of systemic disorders and diseases that affect both organs as well as complex cardio-hepatic interactions. Heart failure can cause acute or chronic liver injury due to ischaemia and passive venous congestion, respectively. Congestive hepatopathy is frequently observed in patients with congenital heart disease and after the Fontan procedure, but also in older patients with chronic heart failure. As congestive hepatopathy can evolve into cirrhosis and hepatocellular carcinoma, screening for liver injury should be performed in patients with chronic cardiac diseases and after Fontan surgery. Fibrosis starts in the centro-lobular zone and will extend progressively to the portal area. Chronic liver injury can be reversible if heart function improves. However, in the case of terminal heart failure, uncontrolled by medical resources or by assistive device support, the combination of heart and liver transplants must be discussed in patients with chronic advanced liver fibrosis. In this review of the literature, we will focus on congestive hepatopathy and its complications, such as liver fibrosis and hepatocellular carcinoma, with the aim of improving the management and surveillance of patients experiencing these complications.

Keywords: ACE, angiotensin-converting enzyme; AFP, α-fetoprotein; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate amino transferase; BNP, B-type natriuretic peptide; Combined heart and liver transplant; Congestive hepatopathy; FALD, Fontan-associated liver disease; FIB-4, Fibrosis-4 index; Fontan-associated liver disease; GGT, gamma-glutamyltransferase; HCC, hepatocellular carcinoma; INR, international normalised ratio; MELD, model for end-stage liver disease; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score.

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Conflict of interest statement

The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Fig. 1
Fig. 1
Pathophysiology of congestive hepatopathies in case of chronic right heart failure and after a Fontan surgery.
Fig. 2
Fig. 2
Natural history of congestive hepatopathies related to chronic right heart failure and to Fontan surgery.
Fig. 3
Fig. 3
Algorithm for the management of congestive hepatopathies.
See this image and copyright information in PMC

References

    1. Møller S., Bernardi M. Interactions of the heart and the liver. Eur Heart J. Sept 2013;34(36):2804–2811. - PubMed
    1. Møller S., Henriksen J.H. Cirrhotic cardiomyopathy. J Hepatol. Juill 2010;53(1):179–190. - PubMed
    1. Izzy M., VanWagner L.B., Lin G., Altieri M., Findlay J.Y., Oh J.K. Redefining cirrhotic cardiomyopathy for the modern era. Hepatology. 2020;71(1):334–345. - PMC - PubMed
    1. Horvatits T., Drolz A., Trauner M., Fuhrmann V. Liver injury and failure in critical illness. Hepatology. 2019;70(6):2204–2215. - PubMed
    1. Sherlock S. The liver IN heart failure relation OF anatomical, functional, and circulatory changes. Br Heart J. Juill 1951;13(3):273–293. - PMC - PubMed