Combined heart and liver transplantation

A single-center experience

Eugenia Raichlin, Richard C. Daly, Charles B. Rosen, Christopher G. McGregor, Michael R. Charlton, Robert P. Frantz, Alfredo L. Clavell, Richard J. Rodeheffer, Naveen L. Pereira, Walter K. Kremers, Sudhir S. Kushwaha, Brooks S. Edwards

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

BACKGROUND. Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx. METHODS. Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1). RESULTS. Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT ≥grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6±53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity. CONCLUSION. Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.

Original languageEnglish (US)
Pages (from-to)219-225
Number of pages7
JournalTransplantation
Volume88
Issue number2
DOIs
StatePublished - Jul 1 2009

Fingerprint

Heart Transplantation
Liver Transplantation
Allografts
Heart Diseases
Fibrosis
Familial Amyloidosis
Restrictive Cardiomyopathy
Heart-Lung Transplantation
End Stage Liver Disease
Hemochromatosis
Biliary Liver Cirrhosis
Calcineurin
Stroke Volume
Kidney Transplantation
Chronic Kidney Failure
Survival Rate
Survival
Mortality
Liver

Keywords

  • Amyloidosis
  • Heart transplantation
  • Liver transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Raichlin, E., Daly, R. C., Rosen, C. B., McGregor, C. G., Charlton, M. R., Frantz, R. P., ... Edwards, B. S. (2009). Combined heart and liver transplantation: A single-center experience. Transplantation, 88(2), 219-225. https://doi.org/10.1097/TP.0b013e3181ac60db

Combined heart and liver transplantation : A single-center experience. / Raichlin, Eugenia; Daly, Richard C.; Rosen, Charles B.; McGregor, Christopher G.; Charlton, Michael R.; Frantz, Robert P.; Clavell, Alfredo L.; Rodeheffer, Richard J.; Pereira, Naveen L.; Kremers, Walter K.; Kushwaha, Sudhir S.; Edwards, Brooks S.

In: Transplantation, Vol. 88, No. 2, 01.07.2009, p. 219-225.

Research output: Contribution to journalArticle

Raichlin, E, Daly, RC, Rosen, CB, McGregor, CG, Charlton, MR, Frantz, RP, Clavell, AL, Rodeheffer, RJ, Pereira, NL, Kremers, WK, Kushwaha, SS & Edwards, BS 2009, 'Combined heart and liver transplantation: A single-center experience', Transplantation, vol. 88, no. 2, pp. 219-225. https://doi.org/10.1097/TP.0b013e3181ac60db
Raichlin E, Daly RC, Rosen CB, McGregor CG, Charlton MR, Frantz RP et al. Combined heart and liver transplantation: A single-center experience. Transplantation. 2009 Jul 1;88(2):219-225. https://doi.org/10.1097/TP.0b013e3181ac60db
Raichlin, Eugenia ; Daly, Richard C. ; Rosen, Charles B. ; McGregor, Christopher G. ; Charlton, Michael R. ; Frantz, Robert P. ; Clavell, Alfredo L. ; Rodeheffer, Richard J. ; Pereira, Naveen L. ; Kremers, Walter K. ; Kushwaha, Sudhir S. ; Edwards, Brooks S. / Combined heart and liver transplantation : A single-center experience. In: Transplantation. 2009 ; Vol. 88, No. 2. pp. 219-225.
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abstract = "BACKGROUND. Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx. METHODS. Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1). RESULTS. Heart and liver transplantation were performed as a single combined procedure in 13 (93{\%}) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100{\%}, 75{\%}, and 60{\%}, respectively, and did not differ from survival after isolated heart transplantation (93{\%}, 83{\%}, and 65{\%}, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT ≥grade 2) for CHLTx was 83{\%} at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6±53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity. CONCLUSION. Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.",
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AU - Frantz, Robert P.

AU - Clavell, Alfredo L.

AU - Rodeheffer, Richard J.

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AU - Kremers, Walter K.

AU - Kushwaha, Sudhir S.

AU - Edwards, Brooks S.

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N2 - BACKGROUND. Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx. METHODS. Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1). RESULTS. Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT ≥grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6±53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity. CONCLUSION. Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.

AB - BACKGROUND. Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx. METHODS. Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1). RESULTS. Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT ≥grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6±53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity. CONCLUSION. Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.

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