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.
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Authors | Pavan Atluri, Ann Gaffey, Jessica Howard, Emily Phillips, Andrew B Goldstone, Nicole Hornsby, John W MacArthur, Jeffrey E Cohen, Jacob Gutsche, Y Joseph Woo |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 98
Issue 3
Pg. 858-62
(Sep 2014)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 25069688
(Publication Type: Journal Article)
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Copyright | Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Topics |
- Female
- Heart Failure
(complications, surgery)
- Heart Transplantation
(methods)
- Humans
- Liver Failure
(complications, surgery)
- Liver Transplantation
(methods)
- Male
- Middle Aged
- Retrospective Studies
- Time Factors
- Treatment Outcome
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