Anesthetic management of a combined heart and liver transplantation in an amyloidotic patient: a case report.

Abstract

Few cases of combined heart and liver transplantation (CHLT) have been reported for familial amyloidosis. Our first CHLT was performed on a female patient with familial amyloidosis due to a genetic defect in transthyretin, characterized by deposition of amyloid in various organs and tissues. This disease produced autonomic heart dysfunction that preceded the development of clinical manifestations and may be an important factor in determining the optimal timing for liver transplantation. CHLT can be performed successfully, even in patients with advanced disease. However, the most compromised patients are more exposed to intraoperative risks, postoperative complications, and worsening of extracardiac and extrahepatic symptoms. Our patient presented severe cardiac dysfunction requiring CHLT. The operative technique is far from being consolidated, despite this, both organs were transplanted in the same day with 2 hours in the intensive care unit (ICU) between surgeries. The outcome of both organs has been favorable. The amyloidotic liver was transplanted to another patient, a sequential (domino) transplantation.

• Authors: I M Barrio, M A Mtnez de Guereñu, M I Real, I Del Campo, F Pérez-Cerdá, E Moreno
• Journal: Transplantation proceedings (Transplant Proc) Vol. 39 Issue 7 Pg. 2458-9 (Sep 2007) ISSN: 0041-1345 [Print] United States
• PMID: 17889217 (Publication Type: Case Reports, Journal Article)

Chemical References

• Prealbumin

Topics

• Amino Acid Substitution
• Amyloidosis, Familial (genetics, surgery)
• Anesthesia (methods)
• Female
• Heart Transplantation
• Hepatectomy
• Humans
• Liver Function Tests
• Liver Transplantation
• Living Donors
• Middle Aged
• Prealbumin (genetics)
• Treatment Outcome