Anesthetic Management of Combined Heart-Liver Transplantation

Abstract

COMBINED HEART AND LIVER transplantation (CHLT), initially reported by Starzl et al 1 Starzl T. Hakala T.R. Shaw B.W. et al. Heart-liver transplantation in a patient with familial hypercholesterolemia. Lancet. 1984; 3: 1382-1383 Abstract Scopus (211) Google Scholar in 1984, has been successfully performed in adults and children. 2 Figuera D. Ardaiz J. Martin-Judez V. et al. Combined transplantation of heart and liver from two different donors in a patient with familial type IIa hypercholesterolemia. J Heart Transplant. 1986; 5: 327-329 PubMed Google Scholar , 3 Wallwork J. Williams R. Calne R. Transplantation of liver, heart, and lungs for primary biliary cirrhosis and primary pulmonary hypertension. Lancet. 1987; 2: 182-184 Abstract PubMed Scopus (79) Google Scholar , 4 Olivieri N. Liu P.P. Sher G.D. et al. Brief report: Combined liver and heart transplantation for end-stage iron-induced organ failure in an adult with homozygous beta-thalassemia. N Engl J Med. 1994; 330: 1125-1127 Crossref PubMed Scopus (66) Google Scholar , 5 Couetil J. Soubrane O. Houssin D.P. et al. Combined heart-lung-liver, double lung-liver, and isolated liver transplantation for cystic fibrosis in children. Transplant International. 1996; 10: 33-39 Crossref Google Scholar , 6 Dennis C.M. McNeil K.D. Dunning J. et al. Heart-lung-liver transplantation. J Heart Lung Transplant. 1996; 15: 536-538 PubMed Google Scholar , 7 Detry O. Honore P. Meurisse M. et al. Advantages of inferior vena cava flow preservation in combined transplantation of the liver and heart. Transpl Int. 1997; 10: 150-151 Crossref PubMed Google Scholar , 8 Surakomol S. Olson L.J. Rastogi A. et al. Combined orthotopic heart and liver transplantation for genetic hemochromatosis. J Heart Lung Transplant. 1997; 16: 573-575 PubMed Google Scholar , 9 Offstad J. Schrumpf E. Geiran O. et al. Plasma exchange and heart-liver transplantation in a patient with homozygous familial hypercholesterolemia. Clin Transpl. 2001; 15: 432-436 Crossref Scopus (30) Google Scholar , 10 Eckhoff D. Frenette L. Sellers M.T. et al. Combined cardiac surgery and liver transplantation. Liver Transpl. 2001; 7: 60-61 Crossref PubMed Scopus (46) Google Scholar , 11 Ruygrok P. Gane E.J. McCall J.L. et al. Combined heart and liver transplantation for familial amyloidosis. Intern Med J. 2001; 31: 66-67 Crossref PubMed Scopus (22) Google Scholar , 12 Praseedom R. McNeil K.D. Watson C.J. et al. Combined transplantation of the heart, lung, and liver. Lancet. 2001; 358: 812-813 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 13 Pirenne J. Verleden G. Nevens F. et al. Combined liver and (heart-) lung transplantation in liver transplant candidates with refractory portopulmonary hypertension. Transplantation. 2002; 73: 140-156 Crossref PubMed Scopus (45) Google Scholar , 14 Gandhi S. Reyes J. Webber S.A. et al. Case report of combined pediatric heart-lung-liver transplantation. Transplantation. 2002; 73: 1968-1969 Crossref PubMed Scopus (18) Google Scholar , 15 Grazi G. Cescon M. Salvi F. et al. Combined heart and liver transplantation for familial amyloidotic neuropathy: Considerations from the hepatic point of view. Liver Transpl. 2003; 9: 986-992 Crossref PubMed Scopus (40) Google Scholar CHLT is an uncommon procedure, with only 37 procedures reported in the United States by the United Network for Organ Sharing Scientific Registry of Transplant Recipients (SRTR) database. 16 UNOS, United Network for Organ Sharing. Available at: http://www.UNOS.org. Accessed February 1, 2006 Google Scholar Historically, there are few indications for CHLT and definitive dual-organ candidacy criteria have not been established. Previous case reports and small series have detailed the surgical procedure and outcomes; however, no reports have detailed intraoperative management strategies to optimize the physiologic support and function of each organ. This manuscript highlights unique anesthetic considerations for the intraoperative management of the CHLT recipient.