Heart and heart-liver transplantation in adults with failing Fontan physiology.

Abstract

BACKGROUND:

As the population of patients with a Fontan palliation grows so does, the number of patients with cardiac failure necessitating orthotopic heart transplant (OHT) and combined heart-liver transplant (CHLT). There is recent evidence that current era cardiac transplant in Fontan patients has improved outcomes, but most studies have a preponderance of pediatrics patients in their cohorts. We examine our institutional experience with adult OHT and CHLT transplantation for failed Fontan physiology.

METHODS AND RESULTS:

Retrospective analysis of patients at the Ahmanson/UCLA Adult Congenital Heart Disease Center who underwent OHT or CHLT for failing Fontan physiology from January 1, 2002 to May 31, 2017. We identified 20 patients with single-ventricle physiology and Fontan palliation who underwent OHT or CHLT. The median age was 29.5 years (range 19-44). Five patients underwent CHLT because of biopsy proven hepatic cirrhosis. The median length of hospital stay was 23 days (range 8-76) post-OHT and 51 days (range 26-77) post-CHLT. During a median follow-up of 56 months (range 2-178), there was one mortality occurring at 34 months post-OHT due to coronary vasculopathy. Most frequent early postoperative complications included bleeding and infection (55% and 20%, respectively) and surgical reintervention for bleeding complications (n = 8, 40%). One CHLT patient experienced clinically significant hepatic rejection requiring admission and steroid treatment.

CONCLUSIONS:

Despite inherent risks and complexities of OHT or CHLT in patients with a failed Fontan, transplant is a reasonable therapy. Peri- and postoperative complications are common and may require surgical reintervention. Continued observation of practices and unifying themes may help improve patient selection, pre- and postoperative treatment and ultimately outcomes.

• Authors: Leigh C Reardon, Eugene C DePasquale, Jana Tarabay, Daniel Cruz, Hillel Laks, Reshma M Biniwale, Ronald W Busuttil, Fady M Kaldas, Sammy Saab, Robert S Venick, Jeannette P Lin, Ali Nsair, Mario C Deng, Abbas Ardehali, Martin Caderias, Amit Iygengar, Jamil A Aboulhosn
• Journal: Clinical transplantation (Clin Transplant) Vol. 32 Issue 8 Pg. e13329 (08 2018) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 29947122 (Publication Type: Journal Article)
• Copyright: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Fontan Procedure (methods)
• Heart Failure (surgery)
• Heart Transplantation (methods)
• Humans
• Liver Transplantation (methods)
• Male
• Middle Aged
• Palliative Care
• Prognosis
• Retrospective Studies
• Young Adult