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Summary of a consensus conference on heart-liver transplantation
Jon Kobashigawa1, Lisa B VanWagner2, Shelley Hall3
1Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
Insights
Combined heart-liver transplantation (CHLT) criteria are being established for patients with severe heart and liver disease. Experts convened to unify guidelines for combined heart-liver transplant candidates, surgical needs, allocation, and post-transplant care.
Area of Science:
- Transplantation Medicine
- Cardiology
- Hepatology
Background:
- Severe heart disease often coexists with liver disease.
- Combined heart-liver transplantation (CHLT) is increasingly performed, particularly in adults with congenital heart disease and Fontan failure.
- Established criteria for CHLT are lacking.
Purpose of the Study:
- To establish interdisciplinary criteria for liver transplantation in CHLT candidates.
- To address surgical considerations, organ allocation, and post-transplant management for CHLT.
- To unify criteria and create a pathway for dual organ transplantation.
Main Methods:
- A virtual consensus conference was convened on June 10, 2022.
- Experts in cardiothoracic and liver transplantation collaborated.
- The conference assessed criteria, surgical aspects, allocation, and post-CHLT management.
Main Results:
- Consensus statements and findings on CHLT criteria were developed.
- The conference aimed to unify interdisciplinary approaches to CHLT.
- Ethical considerations of multiorgan transplantation were debated due to organ shortages.
Conclusions:
- Formal criteria for combined heart-liver transplantation are being established.
- Collaboration between specialties is crucial for optimizing CHLT pathways.
- Addressing organ allocation and ethical issues is vital for the future of CHLT.
Abstract:
Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart failure with associated liver disease from chronic right-sided heart or Fontan failure. However, the criteria for CHLT have not been established. To address this unmet need, a virtual consensus conference was organized on June 10, 2022, endorsed by the American Society of Transplantation. The conference represented a collaborative effort by experts in cardiothoracic and liver transplantation from across the United States to assess interdisciplinary criteria for liver transplantation in the CHLT candidate, surgical considerations of CHLT, current allocation system that generally results in the liver following the heart for CHLT, and optimal post-CHLT management. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical issues related to multiorgan transplantation were also debated. The findings and consensus statements are presented.
