Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 6C
Background: While rare, combined Thoracic/Liver transplants are employed with increasing frequency. Consistent data regarding the technical conduct, patient selection and outcomes in this highly complex group is lacking.
Methods: Patients with end stage cardiac/pulmonary and liver disease who underwent heart-liver (HL) or lung-liver (LL) transplantation were evaluated. Transplants were performed sequentially (thoracic-first approach.) Liver pre-operative pathology were reviewed. (12 consecutive patients, 3 LL and 9 HL tx , 2010-2017, retrospective, single center)
|Organs Transplanted||Indication for transplant||Pre-OLT liver biopsy|
|LL||+ hTERc mutation w/ IPF/portal fibrosis||Nodular Regenerative Hyperplasia (NRH)|
|LL||+hTERc mutation NOS with UIF/hepatic venous obstruction/HPS||Cirr|
|HL||Ischemic cardiomyopathy/cardiac cirrhosis (CC)||Cirr|
|HL||Tricuspid atresia/failed Fontan/CC||Cirr|
|HL||Tricuspid atresia/failed Fontan/CC||Bridging fibr with NRH|
|HL||double outlet right ventricle (DORV), transposition of the great arteries (TGA), mitral atresia||NRH/incomplete cirr|
|HL||DORV, TGA, pulmonic stenosis||Cirr|
|HL||Dextrocardia, single ventricle, right AV valve atresia, subaortic stenosis||Cirr|
Results: Age was 34.8±13.8 years. Median MELD was 12.5 (range 8-40). 56% of HL were secondary to congenital cardiac defects. Median patient follow up was 17 months (range 8-90). Patient survival was 100%. Graft survival was 96%. One graft failure from HAT required re-do liver tx on POD 22. 9 patients had pre-tx liver biopsy (8 with cirr/bridging fibr.) Amongst LL recipients there was one case of ACR (liver and lung). For HL, 3 patients had ≥ 1 episode of ACR (33%), 2 developed AMR (22%) in the heart. One patient had ACR in the liver allograft (11%)
Conclusions: Thoracic/Liver tx have excellent short-term graft and patient survival. Congenital heart disease with cardiac failure and cirrhosis represents a growing indication for HL tx. hTERc mutations is an emerging etiology for LL tx. Establishing the degree of pre-transplant liver disease is crucial to prevent inappropriate allocation of these life-saving organs.
CITATION INFORMATION: Presser N., DiNorcia J., Agopian V., Yersiz H., Farmer D., Busuttil R., Kaldas F. Complex Combined Thoracic/liver Transplant: A Seven Year Experience Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Presser N, DiNorcia J, Agopian V, Yersiz H, Farmer D, Busuttil R, Kaldas F. Complex Combined Thoracic/liver Transplant: A Seven Year Experience [abstract]. https://atcmeetingabstracts.com/abstract/complex-combined-thoracic-liver-transplant-a-seven-year-experience/. Accessed November 15, 2019.
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