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

13 Citations (Scopus)

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

Fingerprint

Heart Transplantation
Liver Transplantation
Liver Diseases
Heart Diseases
Graft Survival
Reoperation
Allografts
Liver
Length of Stay
Familial Amyloidosis
Tissue Donors
Transplants
End Stage Liver Disease
Survival
Hypertrophic Cardiomyopathy
Dilated Cardiomyopathy
Amyloidosis
Infection
Systemic Lupus Erythematosus
Stroke Volume

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Medicine(all)

Cite this

Reich, H. J., Awad, M., Ruzza, A., De Robertis, M. A., Ramzy, D., Nissen, N., ... 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

Combined Heart and Liver Transplantation : The Cedars-Sinai Experience. / Reich, H. J.; Awad, M.; Ruzza, A.; De Robertis, M. A.; Ramzy, D.; Nissen, N.; Colquhoun, Steven D; Esmailian, F.; Trento, A.; Kobashigawa, J.; Czer, L. S.

In: Transplantation Proceedings, Vol. 47, No. 9, 01.11.2015, p. 2722-2726.

Research output: Contribution to journalArticle

Reich, HJ, Awad, M, Ruzza, A, De Robertis, MA, Ramzy, D, Nissen, N, Colquhoun, SD, Esmailian, F, Trento, A, Kobashigawa, J & Czer, LS 2015, 'Combined Heart and Liver Transplantation: The Cedars-Sinai Experience', Transplantation Proceedings, vol. 47, no. 9, pp. 2722-2726. https://doi.org/10.1016/j.transproceed.2015.07.038
Reich HJ, Awad M, Ruzza A, De Robertis MA, Ramzy D, Nissen N et al. Combined Heart and Liver Transplantation: The Cedars-Sinai Experience. Transplantation Proceedings. 2015 Nov 1;47(9):2722-2726. https://doi.org/10.1016/j.transproceed.2015.07.038
Reich, H. J. ; Awad, M. ; Ruzza, A. ; De Robertis, M. A. ; Ramzy, D. ; Nissen, N. ; Colquhoun, Steven D ; Esmailian, F. ; Trento, A. ; Kobashigawa, J. ; Czer, L. S. / Combined Heart and Liver Transplantation : The Cedars-Sinai Experience. In: Transplantation Proceedings. 2015 ; Vol. 47, No. 9. pp. 2722-2726.
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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.",
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AU - Nissen, N.

AU - Colquhoun, Steven D

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N2 - 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.

AB - 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.

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