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Published on: May 29, 2015
Combined heart-liver transplantation: a single-center experience
Lucio Careddu1, Chiara Zanfi2, Antonio Pantaleo1
1Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Insights
Combined heart and liver transplants (CHLT) offer lifesaving solutions for patients with end-stage heart-liver disease. This study shows CHLT is feasible with excellent survival rates, even utilizing the domino technique for more patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Combined heart and liver failure presents a complex clinical challenge.
- Orthotopic heart and liver transplantation (CHLT) is a viable, albeit rare, treatment option.
Purpose of the Study:
- To review the long-term outcomes of patients undergoing combined orthotopic heart and liver transplantation (CHLT).
- To assess the feasibility and efficacy of CHLT, including the use of the domino technique.
Main Methods:
- Retrospective review of 15 patients who underwent CHLT between November 1999 and March 2012.
- Analysis of pre-transplant diagnoses, surgical procedures, peri-operative outcomes, and long-term survival.
- Evaluation of graft rejection rates for both heart and liver grafts.
Main Results:
- No peri-operative mortality was observed in 14 hemodynamically stable patients.
- 1-month, 1-year, and 5-year survival rates were 93%, 93%, and 82%, respectively.
- High rates of freedom from graft rejection were observed for both heart (100%, 90%, 36% at 1, 5, 10 years) and liver grafts (100%, 91%, 86% at 1, 5, 10 years).
- The domino technique was successfully employed in 8 cases, with a mean 1-year survival of 93%.
Conclusions:
- Simultaneous heart and liver transplantation is a feasible and effective procedure for patients with end-stage heart and liver disease.
- The domino technique expands donor availability and allows for the inclusion of high-risk patients.
- CHLT offers a lifesaving option with favorable long-term outcomes in carefully selected patients.
Abstract:
Combined orthotopic heart and liver transplantation (CHLT) is a lifesaving procedure for patients with end-stage heart-liver disease. We reviewed the long-term outcome of patients who have undergone CHLT at the University of Bologna, Italy. Fifteen patients with heart and liver failure were placed on the transplant list between November 1999 and March 2012. The pretransplant cardiac diagnoses were familial amyloidosis in 14 patients and chronic heart failure due to chemotherapy with liver failure due to chronic hepatitis in one patient. CHLT was performed as a single combined procedure in 14 hemodynamically stable patients; there was no peri-operative mortality. The survival rates for the CHLT recipients were 93%, 93%, and 82% at 1 month and 1 and 5 years, respectively. Freedom from graft rejection was 100%, 90%, and 36% at 1, 5, and 10 years, respectively, for the heart graft and 100%, 91%, and 86% for the liver graft. The livers of eight recipients were transplanted as a "domino" with mean overall 1-year survival of 93%. Simultaneous heart and liver transplantation is feasible and was achieved in this extremely sick cohort of patients. By adopting the domino technique, we were able to enlarge the donor cohort and include high-risk patients.
