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En-Bloc Simultaneous Heart-Liver Transplantation in Adult Patients
Nicolas A Brozzi1, Matthias Loebe1, Fouad Ghazi Souki2
1Division of Thoracic Transplantation and Mechanical Circulatory Support, Miami Transplant Institute, Miami, FL.
Insights
En-bloc heart-liver transplantation (HLTx) is a safe technique that reduces operative and ischemic times. This approach offers protection to transplanted organs, leading to excellent 1-year survival rates in discharged patients.
Area of Science:
- Transplantation Surgery
- Cardiovascular Surgery
- Hepatobiliary Surgery
Background:
- Combined heart-liver transplantation (HLTx) is complex, leading to low adoption rates.
- The en-bloc technique aims to simplify the procedure and improve outcomes.
Purpose of the Study:
- To report a case series of adult patients undergoing en-bloc HLTx.
- To describe the technical aspects and discuss the benefits of this transplantation strategy.
Main Methods:
- Retrospective review of five adult patients who received en-bloc HLTx over 18 months.
- Clinical follow-up to 1 year, assessing postoperative mortality, complications, graft rejection, and infection.
Main Results:
- Hospital survival was 80%, with one mortality due to fungal sepsis.
- Major complications included prolonged ventilation and renal insufficiency in 40% of patients.
- Among discharged patients, 1-year survival was 100% with no rejection or infection.
Conclusions:
- The en-bloc HLTx technique is safe and effective.
- It decreases operative and ischemic times, protecting allografts during reperfusion.
- This method provides hemodynamic support via cardiopulmonary bypass.
Introduction:
Complexity of combined heart-liver transplantation has resulted in low adoption rates. We report a case series of adult patients receiving en-bloc heart-liver transplantation (HLTx), describe technical aspects, and discuss benefits of the technique.
Methods:
Retrospective review of patients receiving en-bloc HLTx over 18 months, with clinical follow up to 1 year. Primary outcomes included postoperative mortality and major complications. Secondary outcomes included 1-year survival, cardiac or hepatic allograft rejection, and infection.
Results:
Five patients received en-bloc HLTx. Mean recipient age was 43 years (26-63), and 3 patients were male. Total operative time was 430 minutes (393-480), cold and warm ischemic times of 85 (32-136) and 37.5 (31-47) minutes. Hospital survival was 80%. One patient died on postoperative day 55 due to fungal sepsis. Major postoperative complications included prolonged mechanical ventilation in 2 of 5 patients (40%), and renal insufficiency requiring hemodialysis in 2 of 5 patients (40%). Among patients discharged from hospital 1-year survival was 100%, with no evidence of rejection or infectious complications.
Conclusion:
En-bloc HLTx technique is a safe and effective strategy, decreasing operative times, and allograft ischemic times, whereas offering protection of implanted allografts during early stages of reperfusion while patient is hemodynamically supported on cardiopulmonary bypass.
