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Published on: May 2, 2025
Mortality Outcomes of Combined Heart and Liver Transplantation and Isolated Heart Transplantation Following Fontan
Oscar Holmvard1, Mariana Póvoa-Corrêa1,2, Adriana Macintyre Innocenzi1,3
1D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
Insights
Combined heart-liver transplantation (CHLT) may offer comparable mortality rates to isolated heart transplantation (HT) for Fontan patients. Comprehensive liver evaluation is crucial for transplant candidates with Fontan-associated liver disease.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Fontan-associated liver disease can progress to advanced fibrosis.
- The comparative mortality benefits of combined heart-liver transplantation (CHLT) versus isolated heart transplantation (HT) in Fontan patients are uncertain.
- This systematic review aims to clarify mortality outcomes to aid clinical decision-making.
Conclusions:
- CHLT may offer mortality rates comparable to isolated HT in Fontan patients.
- These findings support considering CHLT for patients with concurrent liver disease.
- Emphasizes the importance of thorough liver evaluation for all transplant candidates.
Background:
Fontan-associated liver disease can progress to advanced fibrosis, raising the potential need for combined heart-liver transplantation (CHLT) in selected patients. However, the benefits of CHLT over isolated orthotopic heart transplantation (HT), particularly in terms of mortality, remain uncertain. In this systematic review, we compared mortality outcomes following CHLT versus HT in patients with Fontan circulation, with the aim of supporting clinical decision-making.
Methods:
This systematic review was conducted according to the 2020 PRISMA guidelines and registered in PROSPERO. PubMed, Scopus, and Embase were searched. Studies examining HT or CHLT in patients with Fontan circulation that provided information about total and/or 1-year mortality were included. Bias risks were assessed using the Newcastle-Ottawa Scale. We used random- and fixed-effect models, depending on heterogeneity, to estimate pooled effects.
Results:
Sixteen studies were included in this analysis. CHLT was associated with a lower mortality rate per patient-year compared to HT (0.03 vs. 0.09; p < 0.01). However, after excluding studies in which transplantations were performed before the year 2000, the difference between groups was no longer statistically significant. One-year mortality rates were also not significantly different between CHLT and HT (0.09 vs. 0.14; p = 0.28), with similar results observed after excluding pre-2000 studies.
Conclusion:
Overall, this systematic review suggests that CHLT may result in mortality rates comparable to those of isolated HT. These findings support the consideration of CHLT in patients with concomitant liver disease and reinforce the importance of comprehensive liver evaluation in transplant candidates.
