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Operative Technique of Donor Organ Procurement for En Bloc Heart-liver Transplantation
Stefan Elde1, Aleah L Brubaker2, Peter A Than2
1Department of Cardiothoracic Surgery, Stanford University, Stanford, CA.
Insights
Combined heart-liver transplantation offers a solution for patients needing a new heart and with severe liver problems. This emerging procedure, especially the en bloc technique, shows promise for better outcomes and wider adoption.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Combined heart-liver transplantation is an emerging option for patients with indications for heart transplantation and severe hepatic dysfunction.
- Fontan-associated liver disease and fibrosis are common in patients with single ventricle physiology, increasing the relevance of combined transplantation.
- Limited centers currently perform this complex procedure, highlighting the need for standardized techniques.
Purpose of the Study:
- To describe a center's en bloc heart-liver procurement technique in detail.
- To facilitate broader use and standardization of the en bloc heart-liver transplantation approach.
Main Methods:
- Detailed description of the en bloc procurement technique for combined heart-liver transplantation.
- Focus on the surgical methodology and logistical considerations.
Main Results:
- The en bloc technique offers potential advantages over sequential transplantation, including improved hemodynamics and reduced bleeding.
- This technique may decrease liver allograft ischemic time and lower rates of graft dysfunction.
- The detailed description aims to enable wider adoption and standardization.
Conclusions:
- The en bloc technique represents a promising approach for combined heart-liver transplantation.
- Standardization of this procurement technique can improve outcomes for complex patient cases.
- Further adoption of this method could expand treatment options for patients with combined cardiac and hepatic failure.
Abstract:
Combined heart-liver transplant is an emerging option for patients with indications for heart transplantation and otherwise prohibitive hepatic dysfunction. Heart-liver transplantation is particularly relevant for patients with single ventricle physiology who often develop Fontan-associated liver disease and fibrosis. Although only performed at a limited number of centers, several approaches to combined heart-liver transplantation have been described. The en bloc technique offers several potential advantages over the traditional sequential technique. Specifically, en bloc heart-liver transplantation may allow improved hemodynamics, decreased bleeding, reduced liver allograft ischemic time, and may result in reduced rates of graft dysfunction. Here we describe our center's en bloc heart-liver procurement technique in detail, with the aim of allowing broader use and standardization of this technique.
