Abstract 16336: Risk Factor and Serological Markers of Liver Cirrhosis In Patients After Fontan Operation
Background: Liver cirrhosis (LC) which may result in hepatic failure and/or cancer has been reported in patients after Fontan operation. Optimal management of LC in Fontan patients remains unclear. The purpose of this study was to clarify the frequency of LC, and to evaluate the risk factors and serological markers to follow Fontan patients (pts).
Material and Method: Retrospective review of CT scan of the liver was carried out in 57pts after Fontan operation. In this study, LC was diagnosed using contrast enhanced CT scan based on the findings of irregular surface, dull edge, regenerative nodule and left lobe enlargement of the liver. Patients were divided into two groups; LC group, and no LC group. Patients' history including age at Fontan operation, duration after Fontan operation, central venous pressure(CVP), and history of total cavo pulmonary connection (TCPC) conversion were compared between LC and no LC group. Serological data including AST, ALT, γ-GTP, t-bil, albumin, type IV collagen 7s, and hyalic acid, and platelet were also compared.
Results: There were 25pts in LC group and 32pts in no LC group. Age at Fontan in LC group was 8.0±5.5 years old(y), and 6.8±6.0y in no LC group(p=0.44). Duration after Fontan in LC group(18.2±6.4y) was significantly longer than in no LC group (14.5±4.8y). CVP in LC group (15.4±3.5mmHg) was not significantly different from that in no LC group (14.3±1.8mmHg, p=0.32). Operation of TCPC conversion for failing Fontan was significantly more frequent in LC group (17/25pts) than in no LC group (7/32pts) (Fisher's exact test, p=0.001). Hyalic acid and γ-GTP were significantly higher in LC group (p=0.0186, and p=0.018). Sixty three percent of pts >20y after Fontan, 64% of pts with hyalic acid>40ng/ml, and 81% of pts with γ-GTP >80IU/l had LC, and these conditions were significant risk factors.
Conclusions: LC is frequent in pts long after Fontan, especially after 20 years. Hyalic acid and γ-GTP may be useful to follow these pts.
- © 2010 by American Heart Association, Inc.