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Published on: August 17, 2022
Heart-liver transplantation using the en bloc technique: A single-center experience over two decades
Danielle M Mullis1, Alyssa Garrison1, Elbert Heng1
1Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Insights
Combined heart-liver transplantation (CHLT) using the en bloc technique offers excellent survival rates and minimal rejection. This approach is ideal for patients with severe heart and liver disease, demonstrating the liver
Area of Science:
- Transplantation immunology
- Cardiovascular surgery
- Hepatology
Background:
- Combined heart-liver transplantation (CHLT) is a critical treatment for patients with concurrent advanced heart and liver disease.
- The en bloc implantation technique for CHLT is performed at a limited number of specialized centers.
- This review examines clinical outcomes and immunoprotective aspects of CHLT, focusing on over two decades of institutional experience with the en bloc method.
Purpose of the Study:
- To review clinical outcomes and immunoprotective effects of combined heart-liver transplantation (CHLT).
- To describe institutional experience with the en bloc implantation technique for CHLT over more than 20 years.
Main Methods:
- A retrospective review of all patients who underwent CHLT using the en bloc technique between January 2003 and July 2023.
- Analysis of recipient and donor characteristics, operative details, and clinical outcomes.
- Kaplan-Meier survival analysis was conducted.
Main Results:
- Twenty patients underwent CHLT via the en bloc technique.
- At a median follow-up of 3.8 years (for 18 survivors), 1-year survival was 94% and 5-year survival was 75%.
- There was 100% freedom from acute and chronic rejection, with no retransplantations due to rejection.
Conclusions:
- CHLT is a vital therapy for patients with multiorgan dysfunction.
- The en bloc technique minimizes cardiac impact, reduces anastomoses, shortens cold ischemia, and aids coagulopathy correction.
- Excellent survival and rare rejection episodes suggest a potential immunoprotective role for the liver in multiorgan transplantation.
Background:
Combined heart-liver transplantation (CHLT) is a definitive therapy reserved for patients with concomitant heart failure and advanced liver disease. A limited number of centers perform CHLT, and even fewer use the en bloc implantation technique. Here we review clinical outcomes and immunoprotective effects following CHLT and describe our institution's more than two decades of experience in performing the en bloc technique.
Methods:
All patients who underwent CHLT at our institution between January 2003 and July 2023 were identified. Recipient and donor characteristics, operative details, and clinical outcomes were assessed. Kaplan-Meier analysis was performed to evaluate survival following CHLT.
Results:
A total of 20 patients underwent CHLT using the en bloc technique at our institution between January 2003 and July 2023. At a median follow-up of 3.8 years for patients who survived the perioperative period (n = 18), estimated survival was 94% at 1 year and 75% at 5 years. There was 100% freedom from acute moderate rejection, acute severe rejection, and chronic rejection in all patients. No patients required retransplantation due to rejection.
Conclusions:
CHLT is a definitive therapy reserved for patients with multiorgan dysfunction. At our institution, the en bloc technique is the preferred operative approach, as it minimizes cardiac insult, requires fewer anastomoses, minimizes cold ischemia time, and allows for rapid correction of coagulopathy. Overall survival for this cohort is excellent. Episodes of acute rejection were rare, providing further support for the idea that the liver may serve an immunoprotective role in multiorgan transplantation.
