Abstract | BACKGROUND: METHODS: A retrospective review was performed of patients undergoing CHLT at our institution from 1999 to 2013. Information related to preoperative organ function, intraoperative management, surgical approach, transfusions, postoperative findings, and 30-day mortality was reviewed. RESULTS: Twenty-seven CHLT were performed, with 4 of the 27 including simultaneous kidney transplantation. Familial amyloidosis was the indication for 21 CHLTs (78%), and 12 of these explanted livers were used for domino transplantations. Nineteen patients (70%) were receiving inotropic infusions at the time of organ availability. Median preoperative model for end-stage liver disease score was 12. Liver transplantation immediately preceded cardiac transplantation in 2 of the 27 cases because of the presence of high titer donor-specific antibodies and the potential of the liver to lead to a reduction in the antibody titer. Venovenous bypass was used in 14 operations (52%) which were performed with the caval interposition approach to liver transplantation, cardiopulmonary bypass during liver transplantation in two cases (7%), and no bypass in 11 operations (41%) performed with caval sparing (piggyback) surgical technique. Postoperatively, median duration of mechanical ventilation, intensive care unit stay, and hospital stay until discharge were 1 day, 5.5 days, and 15 days, respectively. Transfusions in the first 48 hr after CHLT were not substantial in most patients. One patient died within 30 days of CHLT. CONCLUSION: Combined heart- liver transplantation is a life-saving operation that is performed with relatively low mortality and can be successfully performed in select patients with congenital or acquired cardiac disease.
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Authors | David W Barbara, Kent H Rehfeldt, Julie K Heimbach, Charles B Rosen, Richard C Daly, James Y Findlay |
Journal | Transplantation
(Transplantation)
Vol. 99
Issue 1
Pg. 139-44
(Jan 2015)
ISSN: 1534-6080 [Electronic] United States |
PMID | 25140806
(Publication Type: Journal Article)
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Topics |
- Adult
- Aged
- Blood Transfusion
- Female
- Heart Diseases
(complications, diagnosis, mortality, surgery)
- Heart Transplantation
(adverse effects, mortality)
- Humans
- Intensive Care Units
- Kidney Transplantation
- Length of Stay
- Liver Diseases
(complications, diagnosis, mortality, surgery)
- Liver Transplantation
(adverse effects, mortality)
- Male
- Middle Aged
- Minnesota
- Perioperative Care
- Postoperative Complications
(mortality, therapy)
- Respiration, Artificial
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
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