Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography.

AIM: The impact of cardiac dysfunction on the liver is known as cardiac hepatopathy. In certain instances this can result in significant hepatic fibrosis or cirrhosis. The validity of non-invasive tools to assess hepatic fibrosis, such as FibroScan(®) which measures liver stiffness (LSM), has not been established in this setting. We examined the impact of cardiac dysfunction on LSM using FibroScan(®) and the influence of volume changes on LSM. METHODS AND RESULTS: A prospective, cross-sectional study examined the use of FibroScan(®) in subjects with left-sided heart failure (LHF, n = 32), right-sided heart failure (RHF, n = 9), and acute decompensated heart failure (ADHF, n = 8). The impact of volume changes upon LSM was further examined in the ADHF group (pre- and post-diuresis) and in a haemodialysis group (HD, n = 12), pre- and post-ultrafiltration on dialysis. Compared with healthy controls [n = 55, LSM = median 4.4 (25th percentile 3.6, 75th percentile 5.1) kPa], LSM was increased in all the cardiac dysfunction subgroups [LHF, 4.7 (4.0, 8.7) kPa, P = 0.04; RHF, 9.7 (5.0, 10.8) kPa, P < 0.001; ADHF, 11.2 (6.7, 14.3) kPa, P < 0.001]. Alteration in volume status via diuresis did not change the baseline LSM in ADHF [11.2 (6.7, 14.3) to 9.5 (7.3, 21.6) kPa, P > 0.05] with mean diuresis 5051 ± 1585 mL, or ultrafiltration in HD [6.0 (3.6, 5.1) vs. 5.7 (4.8, 7.0) kPa, P > 0.05] with mean diuresis 1962 ± 233 mL. CONCLUSION: Our findings support the concept of increased LSM in the cardiac failure population. LSM was not altered to a statistically significant level with acute volume changes.

Living liver donation: a survey of the attitudes of the public in Great Britain.

BACKGROUND: Living liver donation (LLD) is becoming an accepted way of increasing the donor pool for liver transplantation. The procedure is associated with major ethical difficulties because there is a significant risk of death to the healthy donor. METHODS: We therefore conducted two surveys of the Great Britain population to determine their attitudes to LLD. RESULTS: Approximately three quarters of the population of 1734 adults aged more than 15 years were supportive of LLD. Those in favor were more likely to be men, better educated, and younger. Seventy-four percent were supportive of the donor being reimbursed for costs incurred in donation, and 19% agreed that the donor should be paid for donation, although there was great variation in the amount suggested. Forty-two percent of the population believed that a risk of 1:200 or less was acceptable when donating to a family member, and only 14% believed that this risk was acceptable when donating to a friend. CONCLUSIONS: Most adults in Great Britain are in favor of LLD, although more than half believe that a donor risk of mortality of 1:200 is acceptable.