Date: Saturday, June 5, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:35pm-4:40pm
*Purpose: Combined heart-liver transplantation (CHLT) is now being practiced with increasing regularity and improved outcomes in the United States. We performed the most comprehensive review of all adult patients undergoing CHLT using national registry data.
*Methods: All adult (≥18 years) CHLT recipients in the United Network for Organ Sharing database were included (09/1987-09/2020). Transplant era groups were generated by decade (era 1=1989-2000, era 2=2001-2010, era 3=2011-2020). Survival analysis was conducted by means of Kaplan-Meier method, log-rank test, and Cox regression.
*Results: We identified 369 adult patients receiving CHLT (12/1989-08/2020). Both the number of adult CHLT recipients (R2=0.75, P<0.001) and the number of centers performing CHLT (R2=0.80, P<0.001) have increased over the study period. Cardiac diagnosis was different among the three eras (P=0.03); the most common in the first two eras was restrictive/infiltrative cardiomyopathy, while the most common in era 3 was congenital heart disease. During eras 1 and 2, nearly all CHLTs were sequential-heart first (100% and 97.1%, respectively), while in era 3, 79.9% were sequential-heart first, 13.8% sequential-liver first, and 6.3% simultaneous (P=0.001). The 1-, 3-, and 5-year post-CHLT cumulative patient survival rates were 86.8%, 80.1%, and 77.9%, respectively (Fig. A). Statistically significant differences in unadjusted patient survival were observed between the three transplant eras (P=0.009; Fig. B). In multivariable Cox regression, recipient diabetes (adjusted hazard ratio [aHR]=2.35, 95%CI: 1.23-4.48), receiving CHLT between 1989-2000 compared with 2011-2020 (aHR=5.00, 95%CI: 1.13-22.26), and receiving sequential-liver first CHLT compared with sequential-heart first CHLT (aHR=2.44, 95%CI: 1.15-5.18) were associated with increased risk of post-CHLT mortality. Increasing left ventricular ejection fraction was associated with decreased risk of post-CHLT mortality (aHR=0.96, 95%CI: 0.92-0.99).
*Conclusions: CHLT is an increasingly performed and accessible therapy with evolving recipient demographics and disease etiologies, and excellent outcomes.
To cite this abstract in AMA style:Ziogas IA, Alexopoulos SP, Wu WK, Matsuoka LK, Rauf MA, Izzy M, Perri R, Schlendorf KH, Menachem JN, Shah AS. Adult Combined Liver-Heart Transplantation: The United States Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/adult-combined-liver-heart-transplantation-the-united-states-experience/. Accessed December 7, 2021.
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