*Purpose: Simultaneous Heart-Liver-Kidney transplantation (SHLKTx) is an incredibly rare, high-risk operation undergone by well-selected patients presenting with multi-organ failure. Our center has performed 10 of the 23 SHLKTxs to date. We compared survival and all-cause mortality in SHLKTx patients to those undergoing single- or double-organ heart transplants (HTx) on a national and single-center scale.

*Methods: We performed a retrospective analysis of SHLKTx and HTx recipients from October 1987 to September 2020, using the UNOS Standard Transplant Analysis and Research database. A total of 80,039 HTx patients and 23 SHLKTx patients were included in our analysis. Of these, 660 and 10, respectively, were transplanted at our center. Survival and all-cause mortality were compared using Kaplan-Meier analysis and Cox regression.

*Results: SHLKTx patients had worse baseline clinical status as they were more likely to be diabetic and possess elevated creatinine and serum total bilirubin levels (p <0.05 for all). These three factors were significant predictors of mortality in univariate and multivariate analyses (Multivariate HR: 1.215, 1.044, 1.015, respectively; p <0.0001 for all). However, post-transplant survival was comparable between patients undergoing SHLKTx and those undergoing single- or double-organ HTx on both national and single-center scales (p = 0.85 and p = 0.29, respectively). Furthermore, SHLKTx was not significantly associated with mortality in either national or single-center data, and there was a non-significant trend towards improved survival in our center’s SHLKTx patients compared to our center’s HTx patients and SHLKTx patients from other centers.

*Conclusions: Current data indicates that patients undergoing SHLKTx experience survival and mortality outcomes comparable to those undergoing single- or double-organ heart transplants at both national and single-center levels. Our findings are limited by a lack of long-term follow-up and the rarity of SHLKTx. Further studies are needed to investigate other clinically significant outcomes such as rejection and infection.

« Back to 2021 American Transplant Congress