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Combined Heart and Liver Transplantation: The Cedars-Sinai Experience
1Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States.
Insights
Combined heart-liver transplantation offers acceptable survival for select patients with coexisting heart and liver disease. This infrequent operation showed promising results in our institutional experience.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Combined heart-liver transplantation is an accepted, yet infrequent, treatment for select patients with heart and liver disease.
- Growing optimism surrounds this complex procedure, necessitating analysis of institutional outcomes.
Purpose of the Study:
- To report the institutional experience with combined heart-liver transplantation.
- To evaluate patient and graft survival, rejection rates, infections, and other outcomes.
Main Methods:
- Analysis of all combined heart-liver transplantations performed at Cedars-Sinai Medical Center between 1998 and 2014.
- Primary outcomes assessed: patient and graft survival. Secondary outcomes: rejection, infection, reoperation, length of stay, and readmission.
Main Results:
- Seven heart-liver transplants were performed (6 simultaneous, 1 staged) with a median follow-up of 22.1 months.
- Six-month and 1-year actuarial survivals were 100% and 83.3%, respectively, with mean survival exceeding 4 years.
- No cardiac allograft rejection occurred; one transient liver allograft rejection and one death due to liver dysfunction were observed. Postoperative complications included infections (5 patients) and reoperations (3 patients).
Conclusions:
- Combined heart and liver transplantation provides acceptable patient and graft survival for carefully selected individuals.
- This approach is a viable option for patients with coexisting severe heart and liver disease.
Purpose:
Combined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation.
Methods:
All combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998-2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission.
Results:
There were 7 heart-liver transplants: 6 simultaneous (single donor) and 1 staged (2 donors). Median follow-up was 22.1 (IQR 13.2-48.4) months. Mean recipient age was 50.8 ± 19.5 years. Heart failure etiologies included familial amyloidosis, congenital heart disease, hypertrophic cardiomyopathy, systemic lupus erythematosus, and dilated cardiomyopathy. Preoperative left ventricular ejection fraction averaged 32.3 ± 12.9%. Five (71.4%) patients required preoperative inotropic support; 1 required mechanical circulatory support. The most common indications for liver transplant were amyloidosis and cardiac cirrhosis. Median Model for End-stage Liver Disease score was 10.0 (9.3-13.8). Six-month and 1-year actuarial survivals were 100% and 83.3%, with mean survival exceeding 4 years. No patient experienced cardiac allograft rejection, 1 experienced transient liver allograft rejection, and 1 developed progressive liver dysfunction resulting in death. Five developed postoperative infections and 3 (42.9%) required reoperation. Median ICU and hospital stays were 7.0 (7.0-11.5) and 17.0 (13.8-40.5) days. There were 4 (57.1%) readmissions.
Conclusions:
For carefully selected patients with coexisting heart and liver disease, combined heart and liver transplantation offers acceptable patient and graft survival.
