Combined Heart and Liver Transplantation: The Cedars-Sinai Experience

H. J. Reich, M. Awad, A. Ruzza, M. A. De Robertis, D. Ramzy, N. Nissen, Steven D Colquhoun, F. Esmailian, A. Trento, J. Kobashigawa, L. S. Czer

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose Combined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation. Methods All combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998-2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission. Results There were 7 heart-liver transplants: 6 simultaneous (single donor) and 1 staged (2 donors). Median follow-up was 22.1 (IQR 13.2-48.4) months. Mean recipient age was 50.8 ± 19.5 years. Heart failure etiologies included familial amyloidosis, congenital heart disease, hypertrophic cardiomyopathy, systemic lupus erythematosus, and dilated cardiomyopathy. Preoperative left ventricular ejection fraction averaged 32.3 ± 12.9%. Five (71.4%) patients required preoperative inotropic support; 1 required mechanical circulatory support. The most common indications for liver transplant were amyloidosis and cardiac cirrhosis. Median Model for End-stage Liver Disease score was 10.0 (9.3-13.8). Six-month and 1-year actuarial survivals were 100% and 83.3%, with mean survival exceeding 4 years. No patient experienced cardiac allograft rejection, 1 experienced transient liver allograft rejection, and 1 developed progressive liver dysfunction resulting in death. Five developed postoperative infections and 3 (42.9%) required reoperation. Median ICU and hospital stays were 7.0 (7.0-11.5) and 17.0 (13.8-40.5) days. There were 4 (57.1%) readmissions. Conclusions For carefully selected patients with coexisting heart and liver disease, combined heart and liver transplantation offers acceptable patient and graft survival.

Original languageEnglish (US)
Pages (from-to)2722-2726
Number of pages5
JournalTransplantation Proceedings
Volume47
Issue number9
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Medicine(all)

Fingerprint Dive into the research topics of 'Combined Heart and Liver Transplantation: The Cedars-Sinai Experience'. Together they form a unique fingerprint.

  • Cite this

    Reich, H. J., Awad, M., Ruzza, A., De Robertis, M. A., Ramzy, D., Nissen, N., Colquhoun, S. D., Esmailian, F., Trento, A., Kobashigawa, J., & Czer, L. S. (2015). Combined Heart and Liver Transplantation: The Cedars-Sinai Experience. Transplantation Proceedings, 47(9), 2722-2726. https://doi.org/10.1016/j.transproceed.2015.07.038