Two is better than one: when to consider multiorgan transplant

Area of Science:

• Cardiology
• Nephrology
• Hepatology
• Transplantation Medicine

Background:

• Patients with end-stage heart failure frequently have concurrent end-stage kidney or liver disease.
• Transplantation of multiple organs is often necessary for these complex cases.
• Limited data exist on the risks, benefits, and long-term outcomes of combined heart-kidney and heart-liver transplantation.

Purpose of the Study:

• To review the current data on heart-kidney transplantation (HKT) and heart-liver transplantation (HLT).
• To discuss the risks, benefits, and outcomes associated with these multiorgan transplantations.
• To address the current guidelines and ethical considerations for multiorgan transplantation (MOT).

Main Methods:

• Review of single-centre studies and large database analyses.
• Examination of recent trends in HKT and HLT incidence and outcomes.
• Analysis of ethical considerations and institutional guidelines for MOT.

Main Results:

• The incidence of HKT and HLT has increased, with favorable outcomes reported.
• Studies show benefits including improved survival, freedom from dialysis, and reduced rejection rates.
• Current guidelines for MOT are variable and debated due to ethical concerns.

Conclusions:

• Multiorgan transplantation (MOT) is an effective and necessary treatment for patients with combined end-stage heart and kidney/liver failure.
• MOT is ethically permissible, and early consideration for eligible patients can reduce morbidity and mortality.
• Further research is required to establish appropriate listing criteria and understand long-term outcomes.