Combined Heart – Liver – Kidney Transplantation: A Pioneer Experience in South America

Abstract

Multiorgan dysfunction is common in population with heart failure, particularly, hepatic dysfunction. A heart or liver transplantation procedure performed in isolation itself presents multiple challenges for the perioperative team. Accordingly, combining both transplants yields a vastly more complicated surgery, with many unique multisystem and multidisciplinary considerations. Although combined heart and liver transplantations are being performed with increasing frequency. Case report: Male patient, 56 years old, diagnosed with dilated cardiomyopathy with biventricular dysfunction and cardiac cirrhosis associated with cardiorenal syndrome. He evolved with progressive dyspnea, undergoing frequent paracentesis and hemodialysis, being listed for transplantation, which took place in April 2021. The uptake occurred in a single-piece block consisting of the heart and liver, with the kidneys removed afterwards. The procedure was performed using the block technique, with simultaneous heart and liver implants, with extracorporeal circulation. Orthotopic kidney transplantation occurred after completion of the other two implants. After surgery, the patient was referred to the intensive care unit, where he remained for 6 days and was discharged after 17 days. Hemodialysis was not necessary at any time after surgery. Conclusion: Due to the high morbidity and mortality rates of cardiac surgery in patients with liver cirrhosis, especially those with Child-Pugh C disease, the combined transplantation may be a promising. However, patients should be carefully selected for this complex procedure, especially in these times of organ shortages.