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Combined Heart-Liver Transplantation Has Excellent Long-Term Outcomes

J. A. Steadman1, J. M. Stulak1, A. L. Clavell2, S. S. Kushwaha2, B. S. Edwards2, N. L. Pereira2, B. A. Boilson2, A. Behfar2, R. J. Rodeheffer2, J. A. Dearani1, T. Taner3, R. C. Daly1

1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, 2Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, 3Division of Transplantation Surgery, Mayo Clinic, Rochester, MN

Meeting: 2020 American Transplant Congress

Abstract number: B-253

Keywords: Graft function, Heart transplant patients, Liver transplantation, Multivisceral transplantation

Session Information

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

Session Type: Poster Session

Date: Saturday, May 30, 2020

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

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Combined heart-liver transplants (CHLTx) have been shown to have good short-term outcomes in those with end-stage heart and liver disease: we conducted a comprehensive review of the largest single-center cohort of CHLTx focusing on long-term survival and function of both heart and liver grafts.

*Methods: From 1992 to 2019, 47 CHLTx were performed at our center. Patients were matched in a 1:1 ratio with similar isolated heart transplant (IHTx) recipients on the basis of age, gender, pre-operative comorbidities and heart transplant indication. Overall survival, graft survival, graft function, and biopsy-proven rejection episodes were assessed.

*Results: The most common indication for CHLTx was familial amyloidosis (30 patients, 64%) followed by congenital heart disease with concomitant liver failure (7 patients, 15%). Mean follow-up time was 75 ± 57 months. Survival at 1, 5, 10 and 15 years was similar (94%, 88%, 66% and 44% respectively for CHLTx and 93%, 76%, 59% and 25% for IHTx, p = 0.493). Cardiac function was comparable: the mean EF at 10 years and at last follow-up was 63% and 62% respectively in CHTX and 62% and 60% for IHTx (p = 0.942 and p = 0.379). Freedom from T cell-mediated rejection at last follow-up was greater in CHLTx patients (44% versus 9% in IHTx, p < 0.001) and treatment for rejection was lower in the CHLTx cohort (p = 0.01). The burden of Coronary Artery Vasculopathy was lesser in the CHLTx patients (15% and 29% at 1 and 5 years respectively, 40% and 53% for IHTx patients).

*Conclusions: CHLTx offers comparable survival outcomes and inferior rates of graft rejection compared to IHTx. This study highlights the excellent long-term results for CHLTx patients. In an era of limited organ availability, our outcomes support CHLTx as a robust treatment option for those with amyloidosis or end-stage heart and liver disease.

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To cite this abstract in AMA style:

Steadman JA, Stulak JM, Clavell AL, Kushwaha SS, Edwards BS, Pereira NL, Boilson BA, Behfar A, Rodeheffer RJ, Dearani JA, Taner T, Daly RC. Combined Heart-Liver Transplantation Has Excellent Long-Term Outcomes [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/combined-heart-liver-transplantation-has-excellent-long-term-outcomes/. Accessed May 10, 2025.

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