Combined heart–liver transplantation: Indications, outcomes and current experience

Abstract

Combined heart–liver transplantation is a rare, life-saving procedure that treats complex and often fatal diseases including familial amyloidosis polyneuropathy and late stage congenital heart disease status-post previous repair. There were 159 combined heart–liver transplantations performed between January 1, 1988 and October 3, 2014 in the United States. A multitude of potential techniques to be used for combined heart and liver transplant including: orthotopic heart transplant (OHT) and orthotopic liver transplant (OLT) on full cardiopulmonary bypass (CPB), OHT with CPB and OLT with venovenous bypass (VVB), OHT with CPB and OLT without VVB, enbloc technique and sequential transplantation. Outcomes of combined heart–liver transplant have been demonstrated to be comparable to outcomes of isolated heart and isolated liver transplant. The liver graft may provide some tolerance of other allografts © 2016 Elsevier Inc. All rights reserved.

Liver Dysfunction in Cardiac Surgery – What Causes It and Is There Anything We Can Do?

“…20 The most common indications for CHLT are familial amyloidosis and heart failure associated with cardiac cirrhosis. 18,19,21 Other recipient pathologies include metabolic diseases, alcoholism, primary end-stage cirrhosis associated with cardiomyopathy, and heart failure resulting in liver cirrhosis. 18 Atluri et al described their protocol when patients are being considered for heart transplantation.…”

“…The incidence of acute cardiac rejection also was lower in the CHLT group than in those who underwent cardiac transplantation alone (8.9% v 23.9%, p ¼ 0.002). 17,[21][22][23] The liver appears to offer protection against rejection by other organs when the liver is part of a multiorgan transplantation procedure. There is growing evidence that acute cardiac rejection and cardiac allograft vasculopathy are less common after CHLT.…”

Anesthetic management during the first combined heart-liver transplant performed in Korea: a case report

“…As the majority of CHLT candidates with severe cardiac insufficiency are unable to tolerate the hemodynamic changes that occur during liver transplantation, it is suggested that heart transplantation be performed prior to liver transplantation [ 11 ]. A number of operative strategies have been published, including (1) a separate staged operation involving heart transplantation followed by liver transplantation, (2) heart transplantation on CPB then liver transplantation after discontinuing CPB during the same operation, and (3) heart and liver transplantation both performed on CPB [ 3 ].…”

“…A number of operative strategies have been published, including (1) a separate staged operation involving heart transplantation followed by liver transplantation, (2) heart transplantation on CPB then liver transplantation after discontinuing CPB during the same operation, and (3) heart and liver transplantation both performed on CPB [ 3 ]. The most widely applied technique is performing the heart transplant on CPB, separating from the bypass, and continuing the liver transplant with selective use of venovenous bypass [ 10 11 ].…”

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

“…). The current literature of CHLT outcomes is limited by small sample size and single‐center experiences …”