From congestive hepatopathy to hepatocellular carcinoma, how can we improve patient management?Key points
Anna Sessa,
Manon Allaire,
Pascal Lebray,
Mourad Medmoun,
Alberto Tiritilli,
Pierre Iaria,
Jean-François Cadranel
Affiliations
Anna Sessa
Sorbonne Université, Service d’Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France; Department of Hepatology and Gastroenterology, Policlinico Federico II, Napoli, Italy
Manon Allaire
Sorbonne Université, Service d’Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France; Inserm U1149, Centre de Recherche sur l’Inflammation, France Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France; Corresponding author. Address: Service d'hépato-gastroentérologie et oncologie, Groupe Hospitalier Pitié-Salpétrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; Tel.: 01 42 16 10 34, fax: 01 42 16 11 60.
Pascal Lebray
Sorbonne Université, Service d’Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
Mourad Medmoun
Service d 'Hépato-Gastroentérologie de nutrition et d’Alcoologie, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
Alberto Tiritilli
Service de Cardiologie, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
Pierre Iaria
Service de Cardiologie, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
Jean-François Cadranel
Service d 'Hépato-Gastroentérologie de nutrition et d’Alcoologie, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
Summary: 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.
