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Combined Heart-Liver Transplantation: A Systematic Review of the Literature

I. A. Ziogas1, D. Giannis2, P. Kapsampelis2, A. Giannopoulou2, A. Evangeliou2, K. S. Mylonas2, G. Tsoulfas3, L. K. Matsuoka1, M. I. Montenovo1, M. Izzy1, S. P. Alexopoulos1

1Vanderbilt University Medical Center, Nashville, TN, 2Society of Junior Doctors, Athens, Greece, 3Aristotle University of Thessaloniki, Thessaloniki, Greece

Meeting: 2020 American Transplant Congress

Abstract number: C-285

Keywords: Heart, Heart transplant patients, Liver transplantation, Outcome

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session C: Heart and VADs: All Topics

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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  • Single-Center Analysis of Adult, Combined Heart-Liver Transplant (CHLT) Recipients

*Purpose: Combined heart-liver transplant (CHLT) has been increasingly utilized as the treatment of choice for candidates with dual end-stage organ disease. We aimed to assess the indications, surgical practices and outcomes of CHLT worldwide.

*Methods: We performed a systematic literature review of the PubMed and Scopus databases (end-of-search date: June 22nd, 2019) with respect to the PRISMA statement.

*Results: The search yielded 49 eligible case reports/series, reporting on a total of 175 patients undergoing CHLT (Fig1). Mean patient age was 44.2±13.8 years and 62.7% were male. The indications for transplantation were amyloidosis in 36% (n=63/175; 95%CI: 29.3-43.4), cardiomyopathy in 29.1% (n=51/175; 95%CI: 22.9-36.3), congenital heart disease in 24% (n=42/175; 95%CI: 18.3-30.9), and unknown in 10.9% (n=19/175; 95%CI: 7.0-16.4). Synchronous transplantation (CHLT at the same operation) was performed in 88% (n=154/175; 95%CI: 82.3-92.1), with 74% (n=114/154; 95%CI: 66.6-80.3) being HT first, 7.1% en-block method (n=11/154; 95%CI: 3.9-12.5) and 1.3% LT first (n=2/154; 95%CI: 0.06-4.9). Sequential transplantation (on different dates) was reported in 9.1% (n=16/175; 95%CI: 5.6-14.4), with HT performed before LT in 62.5% (n=10/16; 95%CI: 38.5-81.6) and LT performed before HT in 12.5% (n=2/16; 95%CI: 2.2-37.3). Mean MELD score was 15.6±5.6 at listing, and 13.9±6.6 at transplant, while the mean Child-Pugh score was 8.2±1.8. The mean ejection fraction pre- and post-operatively was 44.5±18.1 and 61.2±4.7, respectively. Total operation time was 818±183 min, donor heart ischemic time was 195±62 min, cardiopulmonary bypass time was 208±81 min, heart cold ischemia time (CIT) was 208±74 min, and liver CIT was 445±150 min. Overall survival rate at 30 days was 95.2% (n=157/165; 95%CI: 90.6-97.7), at 6 months 90.4% (n=113/125; 95%CI: 83.8-94.6), at 1 year 86.7% (n=104/120; 95%CI: 79.3-91.7), at 3 years 74.7% (n=68/91; 95%CI: 64.9-82.6), and at 5 years 65.8% (n=48/73; 95%CI: 54.3-75.6).

*Conclusions: This study highlights the feasibility of CHLT in appropriately selected patients with coexisting heart and liver disease in high-volume transplant centers. With more than 65% 5-year survival, CHLT should be considered as a reasonable treatment option for patients with dual organ failure.

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To cite this abstract in AMA style:

Ziogas IA, Giannis D, Kapsampelis P, Giannopoulou A, Evangeliou A, Mylonas KS, Tsoulfas G, Matsuoka LK, Montenovo MI, Izzy M, Alexopoulos SP. Combined Heart-Liver Transplantation: A Systematic Review of the Literature [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/combined-heart-liver-transplantation-a-systematic-review-of-the-literature/. Accessed March 1, 2021.

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