Related Experiment Video
Updated: Jun 17, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Combined Heart and Liver Transplantation: A Single Center Experience and Review of National Data
Amen Z Kiani1, Jessica Lindemann1, Neeta Vachharajani1
1Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
Insights
Combined heart-liver transplantation (CHLT) offers excellent survival rates for select patients with end-stage heart and liver disease. This single-center study shows high overall and graft survival after CHLT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Combined heart-liver transplantation (CHLT) is a complex procedure for patients with advanced heart and liver failure.
- This study reviews a single center's experience with simultaneous CHLT.
Purpose of the Study:
- To detail the outcomes of simultaneous combined heart-liver transplantation.
- To compare single-center results with national data.
Main Methods:
- Retrospective review of 12 simultaneous CHLT procedures over 12 years.
- Analysis of clinical data, intraoperative, and postoperative outcomes.
- Comparison with the UNOS registry national cohort.
Main Results:
- Twelve CHLTs (5 pediatric, 7 adult) were performed for conditions like congenital heart disease with cirrhosis and amyloidosis.
- En-bloc (67%) and sequential (33%) techniques were used; mean ICU/total LOS was 16/28 days.
- Overall and graft survival rates were 92% at 1, 3, and 5 years, with a median follow-up of 37.5 months.
Conclusions:
- CHLT is a viable option for carefully selected patients with combined end-stage heart and liver failure.
- The procedure is associated with excellent patient and graft survival outcomes.
Background:
Combined heart-liver transplantation (CHLT) is a high-risk procedure that is infrequently performed in select patients with end-stage heart and liver disease. This study details a single center experience with simultaneous (en bloc or sequential) CHLT.
Methods:
This is a single center retrospective review of 12 simultaneous CHLT performed over a 12-year period. Studied variables included basic clinical data, intraoperative and postoperative details, and outcomes. A comparison of our outcomes to the national cohort was also performed using the UNOS registry.
Results:
Twelve CHLTs (five pediatric, seven adult) were performed between 2011 and 2023. Mean age was 32 years (range 7-62 years, 75% male). Congenital heart disease with cardiac cirrhosis (58%) and amyloidosis (25%) were the most common indications. Liver and heart wait list times were 125 and 116 days, respectively. The majority of CHLTs were performed en-bloc (n = 8; 67%) and four (33%) were performed sequentially (liver following heart). Mean post-operative ICU and total length of stay (LOS) were 16 and 28 days, respectively, with six patients requiring unplanned return to OR (three for hemoperitoneum, three for hemopericardium). There were no intraoperative deaths, and one patient died on POD 1 from hyperacute rejection. None of the patients required re-transplant after a median follow-up of 37.5 months. Both overall and graft survival for the cohort at 1-, 3-, and 5-years remained 92%.
Conclusion:
CHLT remains the only viable option for carefully selected patients with end-stage heart and liver failure and is associated with excellent patient outcomes.
