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Combined heart and liver transplantation: a single-center experience
Eugenia Raichlin1, Richard C Daly, Charles B Rosen
1William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA. eraichlin@unmc.edu
Insights
Simultaneous heart and liver transplantation (CHLTx) is a viable procedure for patients with combined end-stage heart and liver disease. Long-term outcomes show excellent survival rates, comparable to isolated heart transplants.
Area of Science:
- Transplantation Surgery
- Cardiology
- Hepatology
Background:
- Simultaneous combined heart and liver transplantation (CHLTx) is a critical intervention for patients with concurrent end-stage heart and liver failure.
- This procedure addresses complex conditions including metabolic disorders and advanced organ damage.
Purpose of the Study:
- To evaluate the long-term outcomes and feasibility of simultaneous combined orthotopic heart and liver transplantation (CHLTx).
Main Methods:
- A retrospective analysis of 15 CHLTx cases performed between 1992 and 2007.
- Included were two heart, liver, and kidney transplants and one heart, lung, and liver transplant.
- Pretransplant diagnoses included familial amyloidosis, hemochromatosis, and primary biliary cirrhosis.
Main Results:
- 13 of 15 patients (93%) underwent successful combined procedures with no perioperative mortality.
- 1, 5, and 10-year survival rates were 100%, 75%, and 60%, comparable to isolated heart transplants.
- Cardiac allograft rejection rates were higher in CHLTx recipients compared to isolated heart transplants, though graft function remained good.
Conclusions:
- Simultaneous heart and liver transplantation is a feasible and effective treatment option for carefully selected patients.
- The procedure demonstrates excellent long-term survival and organ function for suitable candidates.
Background:
Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx.
Methods:
Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1).
Results:
Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT > or =grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6+/-53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity.
Conclusion:
Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.
