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Combined heart-liver transplantation: Indications, outcomes and current experience
Eliza W Beal1, Khalid Mumtaz2, Don Hayes3
1Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Combined heart-liver transplants are a rare but effective treatment for complex diseases. Outcomes are comparable to single organ transplants, with the liver potentially aiding graft tolerance.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Combined heart-liver transplantation is a rare procedure for patients with combined fatal heart and liver diseases.
- Indications include familial amyloidosis polyneuropathy and end-stage congenital heart disease.
Purpose of the Study:
- To review the techniques and outcomes of combined heart-liver transplantation.
- To assess the viability of this complex procedure.
Main Methods:
- Review of 159 combined heart-liver transplantations performed in the US from 1988 to 2014.
- Analysis of various surgical techniques including full cardiopulmonary bypass, venovenous bypass, and en-bloc or sequential transplantation.
Main Results:
- Outcomes of combined heart-liver transplantation are comparable to isolated heart or liver transplants.
- The liver graft may induce tolerance for other transplanted organs.
Conclusions:
- Combined heart-liver transplantation is a viable option for select patients with complex conditions.
- Further research into the immunomodulatory effects of liver grafts in combined transplantation is warranted.
Abstract:
Combined heart-liver transplantation is a rare, life-saving procedure that treats complex and often fatal diseases including familial amyloidosis polyneuropathy and late stage congenital heart disease status-post previous repair. There were 159 combined heart-liver transplantations performed between January 1, 1988 and October 3, 2014 in the United States. A multitude of potential techniques to be used for combined heart and liver transplant including: orthotopic heart transplant (OHT) and orthotopic liver transplant (OLT) on full cardiopulmonary bypass (CPB), OHT with CPB and OLT with venovenous bypass (VVB), OHT with CPB and OLT without VVB, en-bloc technique and sequential transplantation. Outcomes of combined heart-liver transplant have been demonstrated to be comparable to outcomes of isolated heart and isolated liver transplant. The liver graft may provide some tolerance of other allografts.
