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Combined heart and liver transplantation: an updated systematic review
M Frountzas1, N Karampetsou1, C Nikolaou1
1National and Kapodistrian University of Athens, Greece.
Insights
Combined heart and liver transplantation (CHLT) is a complex but safe and effective surgery for end-stage heart and liver failure. Survival rates are promising, though careful patient selection is crucial for optimal outcomes.
Area of Science:
- Cardiovascular Surgery
- Hepatobiliary Surgery
- Transplantation Medicine
Background:
- Combined heart and liver transplantation (CHLT) represents a complex surgical procedure developed over the past 35 years.
- The procedure is indicated for patients with end-stage heart and/or liver failure.
Purpose of the Study:
- To conduct a meta-analysis investigating the safety and efficacy of combined heart and liver transplantation (CHLT).
Main Methods:
- A systematic literature search was performed across multiple databases (MEDLINE, SCOPUS, Embase, etc.) up to April 2020.
- The meta-analysis adhered to PRISMA and AMSTAR guidelines.
- Included data from 16 studies involving 860 patients.
Main Results:
- The overall mortality rate following CHLT was 14.1%.
- One-year and five-year survival rates were 85.3% and 71.4%, respectively.
- Graft rejection rates were 6.1% for the heart and 9.1% for the liver, with an average hospital stay of 25.8 days.
Conclusions:
- Combined heart and liver transplantation (CHLT) is a safe and effective treatment for patients with progressive heart and/or liver failure.
- Strict adherence to surgical indications is essential for successful outcomes.
- Further research comparing CHLT with isolated heart or liver transplantation is warranted.
Introduction:
Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT.
Materials:
The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,® SCOPUS,® ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases.
Results:
Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration.
Conclusions:
Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.
