Addressing Complexities in Fontan Combined Heart-Liver Transplantation: A Collaborative Perspective

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Fontan-associated circulatory failure represents a critical end-stage condition.
• Heart transplantation or combined heart-liver transplantation (CHLT) is the definitive treatment for eligible Fontan patients.
• Fontan physiology presents unique complexities for transplant evaluation and management.

Purpose of the Study:

• To outline the challenges and strategies for successful combined heart-liver transplantation (CHLT) in Fontan patients.
• To emphasize the critical role of a multidisciplinary team in optimizing CHLT outcomes for this specific population.
• To highlight key considerations for patient selection, surgical planning, and perioperative care.

Main Methods:

• Review of current literature and clinical experience regarding CHLT in Fontan survivors.
• Analysis of factors influencing outcomes in heart and liver transplantation for complex congenital heart disease.
• Discussion of multidisciplinary team roles in managing Fontan patients undergoing transplantation.

Main Results:

• Fontan patients require specialized management due to unique hemodynamic and hepatic considerations.
• Successful CHLT outcomes depend on careful patient selection and tailored surgical approaches.
• A collaborative, multidisciplinary strategy is essential throughout the transplant journey.

Conclusions:

• Combined heart-liver transplantation (CHLT) is a viable, albeit complex, option for Fontan circulatory failure.
• Optimizing CHLT in Fontan patients demands a comprehensive, team-based approach encompassing all phases of care.
• Continuous learning and adaptation are crucial for advancing the field of transplantation in this challenging patient group.