Background: Combined heart-liver transplantation (CHLT) is life-saving for patients with end-stage heart-liver diseases. This is a review of patients who underwent CHLT at a single-center.

Methods: We conducted retrospective review of patients who underwent simultaneous combined heart and liver transplantation (n=10) at our institution from 2004-2014.

Results: Nine-patients received CLHT and one-patient received combined liver-heart, and lung transplantation. Median age was 55 (range, 36-67) years, (80%) were male, (70%) were white. Median MELD score was 14 (range, 6-20), and median BMI 27 (range 15-32). Cardiac transplant indications were ischemic cardiomyopathy in (20%), non-ischemic cardiomyopathy in (20%), hemochromatosis in (30%), ATTR-amyloidosis in (10%) and pulmonary hypertension with end stage right heart failure in (20%) of patients. Observed patient survival rates at 1, 3 and 5-years were 100%, 90% and 90% respectively. Two-patients (20%) had one-cardiac rejection episode based on biopsy (ISHLT grade 2R) in the presence of stable cardiac allograft function. There were no liver rejection events in all 10-patients. At 5-year follow-up (n=6), there was no evidence of cardiac allograft vasculopathy by direct angiography. Five patients (50%) developed acute kidney injury requiring renal replacement therapy within 30-days post transplantation. No patients developed end-stage renal failure at the mean follow-up of 69 ± 38 months.

Conclusion: With proper patient selection, favorable short and long-term outcomes can be achieved in patients who receive combined liver-heart transplantation. Post-transplant acute kidney injury is not uncommon; however it is not associated with long-term outcome.

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