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Fontan versus Non-Fontan Combined Heart-Liver Transplantation: Proceed but Cautiously

I. A. Ziogas, W. K. Wu, M. Izzy, A. Shingina, C. Benson, K. L. Mishra, A. S. Shah, N. L. Do, W. G. McMaster, J. N. Menachem, S. P. Alexopoulos

Vanderbilt University Medical Center, Nashville, TN

Meeting: 2022 American Transplant Congress

Abstract number: 1127

Keywords: Heart transplant patients, Heart/lung transplantation, Liver transplantation, Survival

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

Session Information

Session Name: Poster Chat: Heart and Lung

Session Type: Poster Chat

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Hall C

*Purpose: Combined heart-liver transplantation (CHLT) is increasing, corresponding with a growing prevalence of Fontan-associated end-organ damage. We aimed to describe our contemporary institutional experience with CHLT and compare our Fontan and non-Fontan CHLT recipients.

*Methods: All consecutive CHLTs performed at a single high-volume transplant center between April 2017 and November 2021 were included. Patient characteristics were described with summary statistics and survival analysis was performed using the Kaplan-Meier method and the log-rank test.

*Results: 15 consecutive adult recipients underwent sequential CHLT. Cardiac indication was Fontan failure (10), Shone syndrome (1), ischemic cardiomyopathy (1), non-ischemic cardiomyopathy (1), Adriamycin cardiomyopathy (1), and hemochromatosis (1). Liver indication was Fontan-associated liver disease (10), cardiac cirrhosis (2), HCV cirrhosis (2), and hemochromatosis (1). The median age at CHLT was 38 years (interquartile range [IQR]: 34-51), 73.3% were men, and the median waitlist time was 27 days (IQR: 15-104). The median MELD-XI score was 12.6 (IQR: 9.4-15.4) and the median VAST (varices, ascites, splenomegaly, thrombocytopenia) score was 2 (IQR: 2-3). Compared to non-Fontan recipients, Fontan recipients were younger (median 36 vs 50 years, p=0.051) but had longer cardiopulmonary bypass (median 199 vs 126 minutes, p=0.01) and operative times (median 817.5 vs 599 minutes, p=0.01), and larger yet not statistically significant blood product transfusion requirements (median 12.8L vs 6.3L, p=0.25). Five of 15 patients required perioperative extracorporeal membrane oxygenation (ECMO). Of the five, 3 were Fontan patients who subsequently died. Six patients (40%) underwent unplanned re-operation including chest exploration (3), abdominal exploration (1), and combined chest and abdominal exploration (2). The 1-year overall patient survival was 80% (Figure A). The 1-year patient survival was 70% for Fontan and 100% for non-Fontan CHLT recipients (p=0.55; Figure B).

*Conclusions: Although feasible, CHLT for the treatment of Fontan associated end-organ disease is particularly challenging and associated with higher recipient morbidity compared to non-Fontan related CHLT. Advances in cardioprotective strategies during the liver transplant portion of CHLT in Fontan recipients may improve outcomes in this growing high-risk population.

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To cite this abstract in AMA style:

Ziogas IA, Wu WK, Izzy M, Shingina A, Benson C, Mishra KL, Shah AS, Do NL, McMaster WG, Menachem JN, Alexopoulos SP. Fontan versus Non-Fontan Combined Heart-Liver Transplantation: Proceed but Cautiously [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/fontan-versus-non-fontan-combined-heart-liver-transplantation-proceed-but-cautiously/. Accessed May 9, 2025.

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