A Single-Center’s Outcomes of Combined Heart-Liver Transplantation
1Pharmacy, Houston Methodist Hospital, Houston, TX, 2DeBakey Heart and Vascular Associates, Houston Methodist Hospital, Houston, TX, 3Surgery, Houston Methodist Hospital, Houston, TX
Meeting: 2022 American Transplant Congress
Abstract number: 1115
Keywords: Immunosuppression, Induction therapy, Infection, Rejection
Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: The purpose of this study was to evaluate rejection outcomes in our combined heart-liver transplant (CHLT) recipients at 6 months.
*Methods: This is a retrospective, single-centered, observational study evaluating the 6-month outcomes of CHLT. All CHLT from January 2017-May 2021 were included for analysis. The primary outcome of this study was incidence of cardiac allograft rejection within 6 months post-transplant. Protocol endomyocardial biopsies are performed at weeks 1, 2, 3, 4, 6, 8, 10, 12, and months 4, 5, and 6 post-transplant. Secondary outcomes include changes in left ventricular ejection fraction (LVEF), liver enzymes, and donor specific antibody (DSA) development. Surveillance for DSA is performed per protocol based on patient’s sensitization pre-transplant. Other outcomes include mortality and infections within 1 year post-transplant.
*Results: From January 2017-May 2021, there were 218 protocol biopsies performed on 21 CHLT at our institution. At time of transplant, median age was 62 years old and 80.9% of patients were male. Amyloidosis was the most common reason for CHLT (47.6%). Seven (33.3%) patients were sensitized (peak cPRA >20% in either Class I or Class II DSA’s) prior to transplant; 19 (90.5%) patients did not receive induction, per institution protocol. At 6 months post-transplant, only 2 CHLT had cardiac allograft cellular rejection (2R or greater). Both rejections occurred within 2 weeks of transplant and were successfully treated with corticosteroids. There were no cases of AMR. Median LVEF at 6 months was 60-64%. Liver enzymes were stable after transplant and within the first 6 months after transplant. Four CHLT developed weak DSA’s post-transplant that cleared during subsequent monitoring. There were a total of 4 CMV viremia infections and 9 non-CMV infections within 1 year of transplant; median time to infections were 189 and 109 days after transplant, respectively. No CHLT patients expired at any point during the study follow-up period.
*Conclusions: Our center’s experience with CHLT show excellent outcomes with low rates of cardiac allograft rejection and low development of DSA’s within 6 months after transplant.
To cite this abstract in AMA style:
Lincoln RW, Kalvakuri K, Guha A, Bhimaraj A, Suarez EE, Saharia A, Mobley CM, Amirkhosravi F, Krisl J. A Single-Center’s Outcomes of Combined Heart-Liver Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/a-single-centers-outcomes-of-combined-heart-liver-transplantation/. Accessed May 9, 2025.« Back to 2022 American Transplant Congress