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Liver Transplantation Trends and Outcomes for Hereditary Hemorrhagic Telangiectasia in the United States

Iyer, Vivek N. MD1; Saberi, Behnam MD2; Heimbach, Julie K. MD3; Larson, Joseph J.4; Raghavaiah, Suresh5; Ditah, Ivo MD6; Swanson, Karen MD7; Kamath, Patrick S. MD3; Watt, KD MD3; Taner, Timucin MD3; Krowka, Michael J. MD3; Leise, Michael D. MD3

doi: 10.1097/TP.0000000000002491
Original Clinical Science—Liver

Background. Liver arteriovenous malformations (AVM) in hereditary hemorrhagic telangiectasia (HHT) can necessitate liver transplantation. There is limited data on HHT patients undergoing liver transplantation (LT) in the United States.

Methods. Two sources of data were used: (1) Scientific Registry of Transplant Recipients (SRTR) database (1998-2016) (2) Single center liver transplant database (Mayo Clinic Rochester, MN). The aims of this study were (1) to determine trends in LT for HHT-related liver involvement in the United States using the SRTR database; (2) to identify clinical characteristics, indications, and outcomes for LT in HHT.

Results. Thirty-nine HHT patients were listed for LT in the SRTR database from 1998-2016 to 1998-2001 (n = 1); 2002-2005 (n = 4); 2006-2010 (n = 10), and 2011-2016 (n = 24). Twenty-four underwent LT at a median age of 47.5 years (interquartile range, 37.0-58.5 years). Median calculated MELD score at time of LT was 8.0 (interquartile range, 7.0-9.5), and 75% received an exception MELD score. Two status-1 patients died during transplant surgery. Nineteen (86%) patients were alive after a median post-LT follow-up of 48 months, whereas 2 patients were lost to follow-up. Five of the aforementioned HHT patients underwent LT at Mayo Clinic, 4 with high output cardiac failure, and 1 with biliary ischemia. All 5 were alive at the time of last follow-up with good graft function and resolution of heart failure.

Conclusions. Outcomes after LT for HHT patients are excellent with 86% survival after a median follow-up of 48 months and resolution of heart failure. LT listing for HHT has increased in substantially in more recent eras.

1 Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

2 Division of Gastroenterology & Hepatology, Mt. Sinai New York, NY.

3 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.

4 Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

5 BGS Gleneagles Global Hospital, Kengeri, Bangalore, India.

6 Digestive Care, Regions Hospital & HealthPartners Specialty Center Minneapolis, University of Minnesota Medical School, Minneapolis, MN.

7 Pulmonology and Critical Care Medicine, Mayo Clinic, Scottsdale, AZ.

Received 23 April 2018. Revision received 19 August 2018.

Accepted 16 September 2018.

V.N.I. and B.S. share cofirst authorship and contributed equally to this work.

The authors declare no funding or conflicts of interest.

V.I., B.S., J.H., J.L., I.D., S.R., P.K., K.D.W., T.T., M.K., M.L. participated in research design. V.I., B.S., J.H., J.L., I.D., S.R., K.S., P.K., K.D.W., T.T., M.K., M.L. participated in the writing of the article. V.I., B.S., J.H., J.L., S.R., P.K., K.D.W., T.T., M.K., M.L. participated in the performance of the research. V.I., B.S., J.H., J.L., I.D., S.R., K.S., P.K., K.D.W., T.T., M.K., M.L. participated in data analysis.

Correspondence: Michael D. Leise, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. (

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