Hepatic and renal function with successful long-term support on a continuous flow left ventricular assist device

Introduction: Data regarding the long-term clinical effects of a continuous flow left ventricular assist device (CF-LVAD) on hepato-renal function is limited. Hence our aim was to assess changes in hepato-renal function over a one-year period in patients supported on a CF-LVAD. Methods: During the study period 126 patients underwent CF-LVAD implant. Changes in hepato-renal laboratory parameters were studied in 61/126 patients successfully supported on a CF-LVAD for period of one year. A separate cohort of a high-risk group (HCrB) of patients (56/126) with a serum creat. >. 1.9. mg/dL (168. μmol/L) (75th percentile) or a serum bil. >. 1.5. mg/dL (25.65. μmol/L) (75th percentile) was created. Changes in serum creatinine and bilirubin were analysed at regular intervals for this group along with the need for renal replacement therapy. Results: Baseline creatinine and blood urea nitrogen (BUN) for the entire cohort was 1.4[1.2,1.9. mg/dL] [123.7(106,168). μmol/L) and 27[20,39.5. mg/dL] [9.6(7.1,14.1). mmol/L] respectively. After an initial reduction at the end of one month [1(0.8,1.2). mg/dL; 88(70,105). μmol/L] (p< 0.0001), a gradual increase was noted over the study period to reach (1.25[1.1,1.5]. mg/dL; 106(97.2,132.6). μmol/L] (p= 0.0003). The serum bilirubin normalised from a [1(0.7,1.55). mg/dL] [17(18.8,25.7). μmol/L) to 0.9(0.6,1.2). mg/dL [15.4(10.2,20.5) μmol/L] (p= 0.0005) and continued to decline over one year. Improvement in the synthetic function of the liver was demonstrated by a rise in the serum albumin levels to reach 4.3[4.1,4.5] [43(41,45). gm/L] at the end of one year (p< 0.0001).The baseline serum creatinine and bilirubin for the high-risk cohort (HCrB) was 1.9(1.3,2.4). mg/dL [168(115,212). μmol/L] and 1.7(1.00,2.4). mg/dL [29(17.1,68.4). μmol/L] respectively. The high-risk cohort (HCrB) demonstrated a trend towards higher 30-day mortality (p= 0.06). While the need for temporary renal replacement therapy was higher in this cohort (16% vs. 4%; p= 0.03), only 3% need it permanently. A significant reduction in creatinine was apparent at the end of one month [1.1(0.8,1.4). mg/dL; 97(70.7,123.7). μmol/L] (p< 0.0001) and then remained stable at [1.3(1.1,1.5). mg/dL; 115(97,132.6). μmol/L]. Bilirubin demonstrated a 30% decline over one month and then remained low at [0.7(0.5,0.8). mg/dL; 62(44,70). μmol/L] p= 0.0005 compared to the pre-operative baseline. Conclusion: Hepato-renal function demonstrates early improvement and then remains stable in the majority of patients on continuous flow left ventricular assist device support for one year. High-risk patients demonstrate a higher 30-day mortality and temporary need for renal replacement therapy. Yet even in this cohort, improvement is present over a period of one year on the device, with a minimal need for permanent haemodialysis.