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Combined heart and liver transplantation: the Cleveland Clinic experience
A Dave Nagpal1, Themistokles Chamogeorgakis, Alexis E Shafii
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Insights
Combined heart-liver transplantation (CHLT) offers excellent survival rates for patients with end-stage cardiac and liver disease. This review highlights successful CHLT outcomes, demonstrating its viability as a life-saving procedure.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Combined heart-liver transplantation (CHLT) is a critical intervention for patients with advanced cardiac and hepatic conditions.
- Existing data on CHLT techniques and outcomes are diverse, necessitating further clinical experience sharing.
Purpose of the Study:
- To review the Cleveland Clinic's experience with combined heart-liver transplantation.
- To evaluate the outcomes and perioperative management of CHLT recipients.
Main Methods:
- Retrospective chart review of patients undergoing simultaneous heart and liver transplantation.
- Data collected from January 2006 to December 2012.
Main Results:
- Five patients underwent CHLT, with nonischemic cardiomyopathy and hepatitis C or amyloidosis as primary pathologies.
- Mean patient age was 49 years; 100% survival at a mean of 38 months post-transplant.
- No instances of cardiac or hepatic graft dysfunction or rejection were reported; one readmission for gastroenteritis.
Conclusions:
- CHLT can achieve excellent outcomes in critically ill patients.
- Findings contribute to the understanding of perioperative management for CHLT recipients.
Background:
Combined heart-liver transplantation (CHLT) has been utilized as a life-saving procedure in those with end-stage cardiac and hepatic pathology. Techniques and outcomes of this procedure are varied. We sought to review the Cleveland Clinic experience with CHLT.
Methods:
This study is a retrospective chart review of patients who received simultaneous heart and liver transplantation between January 2006 and December 2012.
Results:
Five patients received CHLT. The mean age was 49 (± 20) years. All cardiac pathology was nonischemic cardiomyopathy, with a mean ejection fraction of 0.36 (± 0.13). Three of the 5 were on preoperative inotropic support, 1 of which required placement of a total artificial heart for support pretransplant. Liver pathology was amyloid in 1 patient and hepatitis C in the remaining 4. Mean Model for End-Stage Liver Disease score was 17 (± 5), and mean Childs-Pugh score was 8 (± 1). Survival, now at a mean of 38 (± 20) months remains 100%, with no cardiac or hepatic graft dysfunction or episodes of rejection. One hospital readmission was required for gastroenteritis at 15 months posttransplant.
Conclusions:
These results suggest that excellent outcomes can be achieved in this extremely sick cohort of patients, and add to the growing literature of perioperative management of CHLT recipients.
