370 - Simultaneous Heart-Liver or Isolated Heart Transplantation for Patients with Heart Failure and Liver Disease

Abstract

Background: Combined Heart-Liver Transplantation has emerged as a good option in selected patients with end stage heart and liver disease. However, some patients have progressive heart failure while awaiting dual-organ transplantation necessitating isolated heart transplantation. The outcome of such approach is largely unknown. Methods: We reviewed all adult patients listed for heart-liver transplantation in the UNOS registry between 1987 and 2015. Patients were divided by the transplanted organ into heart only (HT) and heart-liver simultaneous transplantations (HLT). Comparative and survival analyses were performed. Results: We identified a total of 219 patients listed for HLT. Of those, 185 (84.5%) received HLT and 34 received HT. Median age 50 [39–58] years, 159 (73%) were male, 153 (70%) were white. Median total bilirubin was 1 [0.7–1.6] mg⋅dL−1 and median serum albumin was 3.8 [3.4–4.3] g/dL. Patients in the two groups were similar in age, sex, race, UNOS status, total bilirubin, serum albumin, creatinine, blood type, cardiac output, pulmonary pressures, or time spent on the wait-list (P = NS for all comparisons). Overall survival was lower in patients who underwent isolated HT compared with dual-organ HLT (1, 5, 10-year: 75%, 55%, 36% vs 87%, 81%, 57%, Log Rank P = .001). Conclusions: About 16% of patients listed for dual heart-liver transplantation end up receiving isolated heart transplantation. Among patients listed for HLT, isolated heart transplantation is associated with worse survival than simultaneous dual organ transplantation.