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Long-Term Follow-Up in Liver Transplantation and Combined Cardiac Surgery: Validation and Refinement of the LT+CS

Laura B Oliveira1, Chase J Wehrle1, Sarah Wehbe1

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Summary
This summary is machine-generated.

Combined liver and cardiac surgery offers survival benefits for patients with end-stage liver disease and cardiac dysfunction. Refined risk scores improve patient selection and outcomes in this complex procedure.

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Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Surgery

Background:

  • Combined liver transplantation and cardiac surgery (LT+CS) is a critical option for patients with end-stage liver disease (ESLD) and severe cardiac dysfunction.
  • Limited evidence exists on long-term outcomes and prognostic factors for this complex procedure.

Purpose of the Study:

  • To evaluate long-term survival and identify prognostic factors in patients undergoing combined LT+CS.
  • To validate and refine the LT-CS risk score using machine learning techniques.

Main Methods:

  • Analysis of 46 patients who underwent single-staged LT+CS between 2005-2023 with at least 1-year follow-up.
  • Utilized univariate and multivariate Cox proportional hazards models to identify predictors of survival.
  • Employed Leave-One-Out Cross-Validation (LOOCV) for risk score refinement and validation.

Main Results:

  • One- and five-year survival rates were 74.2% and 50%, respectively.
  • Chronic kidney disease (CKD) was a significant negative predictor of 5-year survival (HR=12.28).
  • The refined LT-CS-2.0 score demonstrated good predictive accuracy (AUC=0.683 for 5-year OS) and risk stratification capabilities.

Conclusions:

  • Combined LT and CS can achieve acceptable survival rates in carefully selected patients.
  • The LT-CS-1.0 risk score has improved survival rates, and the LT-CS-2.0 score offers further potential for risk stratification.
  • This approach should be considered in specialized centers for appropriate patient candidates.