Combined Heart and Liver Transplant: Indication, Patient Selection, and Allocation Policy

Zhao, Kai; McLean, Rhondalyn C.; Hoteit, Maarouf; Olthoff, Kim M.

doi:10.1002/cld.812

Cited by 31 publications

(22 citation statements)

References 12 publications

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“…These findings underscore the importance of appropriate patient and donor selection for CHLT based on individual patient and donor characteristics, as well as the need for thoughtful pre-operative planning among surgeons from both heart and liver disciplines [ 12 , 17 – 20 ]. Despite all of these challenges, the reported survival outcomes of CHLT are similar to those of heart transplant alone [ 4 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Adult Combined Heart-Liver Transplantation: The United States Experience

Alexopoulos

Ziogas

et al. 2022

Transpl Int

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Background: We aimed to review the indications and outcomes of adults undergoing combined heart-liver transplantation (CHLT) in the US using national registry data.Methods: Adult (≥18 years) CHLT recipients in the United Network for Organ Sharing database were included (09/1987–09/2020; era 1 = 1989–2000, era 2 = 2001–2010, era 3 = 2011–2020). Survival analysis was conducted by means of Kaplan-Meier method, log-rank test, and Cox regression.Results: We identified 369 adults receiving CHLT between 12/1989–08/2020. The number of adult CHLT recipients (R2 = 0.75, p < 0.001) and centers performing CHLT (R2 = 0.80, p < 0.001) have increased over the study period. The most common cardiac diagnosis in the first two eras was restrictive/infiltrative cardiomyopathy, while the most common in era 3 was congenital heart disease (p = 0.03). The 1-, 3-, and 5-years patient survival was 86.8, 80.1, and 77.9%, respectively. In multivariable analysis, recipient diabetes [adjusted hazard ratio (aHR) = 2.35, 95% CI: 1.23–4.48], CHLT between 1989-2000 compared with 2011–2020 (aHR = 5.00, 95% CI: 1.13–22.26), and sequential-liver first CHLT compared with sequential-heart first CHLT (aHR = 2.44, 95% CI: 1.15–5.18) were associated with increased risk of mortality. Higher left ventricular ejection fraction was associated with decreased risk of mortality (aHR = 0.96, 95% CI: 0.92–0.99).Conclusion: CHLT is being increasingly performed with evolving indications. Excellent outcomes can be achieved with multidisciplinary patient and donor selection and surgical planning.

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Section: Discussionmentioning

confidence: 99%

Adult Combined Heart-Liver Transplantation: The United States Experience

Alexopoulos

Ziogas

et al. 2022

Transpl Int

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“…In FAP, the liver is transplanted to avoid ongoing damage to the cardiac allograft. A consistent observation regardless of the indication is that cardiac dysfunction is the primary driver of combined organ transplant [ 118 , 119 , 120 ]. Until recently, FAP remained the most common indication of CHLT in the US.…”

Section: Determining Candidacy For Heart Transplantationmentioning

confidence: 99%

Congestive Hepatopathy

Fortea

Puente

Cuadrado‐Lavín

et al. 2020

IJMS

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Liver disease resulting from heart failure (HF) has generally been referred as “cardiac hepatopathy”. One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis (“cardiac cirrhosis”) and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a “reversed lobulation” pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.

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“…The fundamental motivator of mixed organ transplant is cardiac failure, regardless of the rationale. Until recently, FAP was the most common sign of CHLT in the United States [3,[28][29][30].…”

Section: Managementmentioning

confidence: 99%

Overview on Cardiac Cirrhosis and Congestive Hepatopathy - A Review

Hussein

Almujil

Banheem

et al. 2021

JPRI

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Cardiac cirrhosis (congestive hepatopathy) refers to a group of hepatic abnormalities that develop as a result of right-sided heart failure. Cirrhosis of the liver can be induced by any right-sided pathology that leads to right-sided heart failure, which leads to increased venous congestion and pressure in the hepatic sinusoids. Because cardiac cirrhosis might be asymptomatic or diagnosed incorrectly due to other types of liver disease, determining its prevalence is difficult. The underlying heart disease, rather than the hepatic congestion and damage, is usually the cause of death in cardiac cirrhosis. The control of the underlying cardiac disease, as well as the optimization of cardiac output, are the mainstays of congestive hepatopathy treatment. Diuresis can help with hepatic congestion, but it must be used with caution to avoid causing hepatic ischemia. Hemodynamic therapy may be able to reverse the early stages of congestive hepatitis. The widespread use of heart transplantation (HT) and considerable breakthroughs in medical and surgical treatments have drastically altered the profile of CH patients. In this overview we will be looking at the disease cause, epidemiology, diagnosis, and treatment.

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Combined Heart and Liver Transplant: Indication, Patient Selection, and Allocation Policy

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/13-6-reading-zhao a video presentation of this article

Cited by 31 publications

References 12 publications

Adult Combined Heart-Liver Transplantation: The United States Experience

Adult Combined Heart-Liver Transplantation: The United States Experience

Congestive Hepatopathy

Overview on Cardiac Cirrhosis and Congestive Hepatopathy - A Review

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