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Updated: Apr 26, 2026
Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration
Published on: May 29, 2015
Combined heart and liver transplantation can be safely performed with excellent short- and long-term results
Pavan Atluri1, Ann Gaffey1, Jessica Howard1
1Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Combined heart and liver transplants are feasible and show excellent survival rates. This dual organ transplant may offer immunologic protection for the heart allograft, improving outcomes for end-stage heart failure patients.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Heart transplantation is standard for end-stage heart failure, but hepatic failure is a contraindication.
- Combined heart-liver transplantation is emerging for dual organ failure, with limited outcome data.
- This study analyzes a large single-center experience with combined heart-liver transplants.
Purpose of the Study:
- To evaluate the feasibility and outcomes of combined heart-liver transplantation.
- To determine short-term and long-term survival after dual organ transplant.
- To investigate potential immunologic benefits of liver transplantation on cardiac allografts.
Main Methods:
- Review of 26 patients undergoing combined heart and liver transplant at a single center.
- Analysis of demographic, perioperative, and survival data.
- Kaplan-Meier survival analysis and assessment of graft rejection.
Main Results:
- All 26 dual organ transplants were successful without primary graft dysfunction.
- Average ICU stay was 10 days, and average hospital stay was 25 days.
- Excellent survival: 1-year (87%) and 5-year (83%). Only 11% showed long-term rejection, suggesting immunologic protection.
Conclusions:
- The largest single-center series of combined heart-liver transplants demonstrates high feasibility.
- Excellent long-term survival rates were achieved with this dual organ strategy.
- Concomitant liver transplantation may provide significant immunologic protection for the cardiac allograft.
Background:
Heart transplant has become the gold standard therapy for end-stage heart failure. Short- and long-term outcomes after orthotopic heart transplant have been excellent. Many patients with heart failure manifest hepatic failure as a result of a chronically elevated central venous pressure. Concomitant hepatic failure has been a contraindication to heart transplant in most centers. A few select institutions are currently performing combined heart-liver transplantation to treat dual organ failure. The outcomes after dual organ transplant are largely unknown, with limited data from a few select centers. We undertook this study to analyze our large experience with combined heart-liver transplant and determine the short-term and long-term outcomes associated with this procedure.
Methods:
We have performed 1,050 heart transplants at our center to date. Of these patients, 26 underwent combined heart and liver transplant (largest single-center experience). We reviewed demographic, perioperative, and short- and long-term outcomes after this combined procedure.
Results:
All 26 patients underwent successful dual organ transplant, without any episodes of primary graft dysfunction. Average length of intensive care unit stay was 10 ± 5 days, and average hospital stay was 25 ± 11 days. Kaplan-Meier analysis demonstrated excellent short-term survival (1 year, 87% ± 7%) and long-term survival (5 years, 83% ± 8%). Interestingly, only 3 patients (11%) demonstrated any evidence of rejection long-term by myocardial biopsy, suggesting that concomitant hepatic transplantation may provide immunologic protection for the cardiac allograft.
Conclusions:
We present the largest single-center series of combined heart and liver transplant. This dual organ strategy is highly feasible, with excellent long-term survival. Concomitant liver transplant may confer immunologic protection for the cardiac allograft.
