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Pediatric combined heart-liver transplantation performed en bloc: a single-center experience
Amy L Hill1, Katsuhide Maeda, Clark A Bonham
1Department of Surgery, Stanford University, Stanford, CA, USA.
Insights
En bloc pediatric combined heart and liver transplants (CHLT) offer operative and immunologic benefits for low-risk patients. This approach, when performed by experienced surgeons, can lead to excellent patient and graft survival rates.
Area of Science:
- Pediatric Transplant Surgery
- Immunology
- Hepatology
- Cardiology
Background:
- Pediatric combined heart and liver transplantation (CHLT) is a complex procedure rarely performed, especially en bloc.
- Existing literature lacks comprehensive data on the outcomes of en bloc CHLT in pediatric populations.
Purpose of the Study:
- To evaluate the safety and efficacy of en bloc pediatric CHLT in a single institution.
- To assess operative and immunologic outcomes in a cohort of low-immunologic-risk pediatric patients undergoing en bloc CHLT.
Main Methods:
- Retrospective review of three pediatric patients with end-stage heart and liver disease from 2006-2010.
- All patients underwent en bloc CHLT performed by a single experienced surgeon.
- Data collected included patient/graft survival, rejection episodes, infections, operative time, transfusion needs, and immunosuppression.
Main Results:
- Achieved 100% one-year patient and graft survival rates.
- No instances of antibody-mediated or cell-mediated rejection were observed.
- Zero postoperative infections and no opportunistic infections at one year; all patients maintained on steroid-free immunosuppression.
Conclusions:
- En bloc pediatric CHLT is a viable option for carefully selected low-immunologic-risk patients with end-stage heart and liver disease.
- This surgical approach, when executed by experienced surgeons, demonstrates significant operative and immunologic advantages.
- En bloc CHLT can lead to equivalent or improved patient and graft outcomes compared to conventional methods.
Abstract:
Pediatric CHLT is rarely performed in transplant centers and even fewer are performed en bloc. In the hands of an experienced surgeon with the appropriate patient selection, CHLT performed en bloc may have several operative and immunologic benefits, thereby resulting in improved outcomes for the transplant recipient. A single-institutional, retrospective review from 1/1/06 to 12/31/10 was conducted. Three pediatric patients with end-stage heart and liver disease who were considered low immunologic risk were included. All were managed by the same surgeon with a herein-described CHLT donor and recipient operation. Data were collected on patient and graft survival, rejection episodes, infectious complications, operative time, intraoperative transfusion requirements, and immunosuppression regimens. One-yr patient and graft survival rates were 100%. No patients experienced antibody-mediated or cell-mediated rejection. No patients had postoperative infections, and all patients were free of opportunistic infections at one-yr post-transplant. All patients were maintained safely on steroid-free immunosuppression. There were no intraoperative complications. In pediatric end-stage heart and liver disease patients with low immunologic risk, it is reasonable to proceed with en bloc CHLT so long as there is an experienced surgeon to perform the case. This offers operative and immunologic advantages to the recipient while maintaining equivalent, if not improved, recipient and graft outcomes.
