Anesthetic management during the first combined heart-liver transplant performed in Korea: a case report

Area of Science:

• Anesthesiology
• Cardiology
• Hepatology
• Transplant Surgery

Background:

• Combined heart-liver transplantation (CHLT) is a rare but feasible procedure for patients with combined cardiac and hepatic failure.
• Accumulating evidence supports CHLT as a viable option for complex cases.
• Coexisting heart and liver failure presents significant physiological challenges.

Purpose of the Study:

• To describe the anesthetic management during the first CHLT performed in Korea.
• To highlight the specific anesthetic considerations and challenges in CHLT.
• To share insights from a complex case involving dual organ failure.

Main Methods:

• Anesthetic management for a 45-year-old female patient with severe cardiac dysfunction requiring ECMO and congestive hepatopathy.
• Consecutive heart and liver transplantation utilizing extracorporeal circulatory support.
• Detailed description of anesthetic techniques during heart transplant with cardiopulmonary bypass and liver transplant with peripheral ECMO.

Main Results:

• Successful completion of the first CHLT in Korea.
• Demonstration of feasible anesthetic strategies for complex CHLT cases.
• Management of dual pathophysiology challenges during the transplant procedure.

Conclusions:

• CHLT is a feasible treatment option for patients with end-stage heart and liver disease.
• Careful anesthetic planning and management are crucial for successful CHLT.
• This case provides valuable insights into managing patients with combined cardiac and hepatic failure undergoing transplantation.