Combined heart and liver transplantation can be safely performed with excellent short- and long-term results.
Publication/Presentation Date
9-1-2014
Abstract
BACKGROUND: Heart transplant has become the gold standard therapy for end-stage heart failure. Short- and long-term outcomes after orthotopic heart transplant have been excellent. Many patients with heart failure manifest hepatic failure as a result of a chronically elevated central venous pressure. Concomitant hepatic failure has been a contraindication to heart transplant in most centers. A few select institutions are currently performing combined heart-liver transplantation to treat dual organ failure. The outcomes after dual organ transplant are largely unknown, with limited data from a few select centers. We undertook this study to analyze our large experience with combined heart-liver transplant and determine the short-term and long-term outcomes associated with this procedure.
METHODS: We have performed 1,050 heart transplants at our center to date. Of these patients, 26 underwent combined heart and liver transplant (largest single-center experience). We reviewed demographic, perioperative, and short- and long-term outcomes after this combined procedure.
RESULTS: All 26 patients underwent successful dual organ transplant, without any episodes of primary graft dysfunction. Average length of intensive care unit stay was 10 ± 5 days, and average hospital stay was 25 ± 11 days. Kaplan-Meier analysis demonstrated excellent short-term survival (1 year, 87% ± 7%) and long-term survival (5 years, 83% ± 8%). Interestingly, only 3 patients (11%) demonstrated any evidence of rejection long-term by myocardial biopsy, suggesting that concomitant hepatic transplantation may provide immunologic protection for the cardiac allograft.
CONCLUSIONS: We present the largest single-center series of combined heart and liver transplant. This dual organ strategy is highly feasible, with excellent long-term survival. Concomitant liver transplant may confer immunologic protection for the cardiac allograft.
Volume
98
Issue
3
First Page
858
Last Page
862
ISSN
1552-6259
Published In/Presented At
Atluri, P., Gaffey, A., Howard, J., Phillips, E., Goldstone, A. B., Hornsby, N., MacArthur, J. W., Cohen, J. E., Gutsche, J., & Woo, Y. J. (2014). Combined heart and liver transplantation can be safely performed with excellent short- and long-term results. The Annals of thoracic surgery, 98(3), 858–862. https://doi.org/10.1016/j.athoracsur.2014.04.100
Disciplines
Medicine and Health Sciences
PubMedID
25069688
Department(s)
Department of Surgery
Document Type
Article