Combined Pediatric Heart-Liver Transplant Outcomes in the US: A 25 Year National Cohort Study

Abstract

Purpose Pediatric combined heart-liver transplantation (cHLTx) remains uncommon in the United States and criteria for cHLTx are unclear. The objective of this study was to review the indications, and outcomes of pediatric cHLTx. Methods Data from the Scientific Registry for Transplant Recipients heart and liver databases were used to identify 9245 pediatric heart transplants (PHTx) alone, 14134 pediatric liver transplant alone, and 20 pediatric cHLTx (16 simultaneous HLTx [same organ donor], + 4 previous heart transplants followed by liver transplant [different organ donors]) (age ≤ 21 years) between 1992 and 2017. Outcomes included patient survival, and 1-year rates of acute heart and liver rejection. Results The median age for pediatric cHLTx was 15.6 (IQR: 10.5, 17.9) years, and included 12 males (12/20=60%). In the cHLTx group, the most common indication for heart transplant was congenital heart disease (11/20=55%), and the most common indication for liver transplant was cirrhosis (9/20=45%) due to granulomatous diseases including sarcoidosis, histiocytosis or cryptogenic. Recipients of pediatric cHLTx had a similar 5-year adjusted risk of death compared to PHTx alone (p=0.9; Figure 1). The 1, 3, and 5 year actuarial survival rates in pediatric cHLTx recipients was 80%, 80%, and 80% respectively, and was similar to isolated PHTx alone (88%, 82%, and 78% respectively. There was no heart or liver rejection reported in the cHLTx group versus 9.9% in heart only and 10.6% in liver transplant only group, respectively. Conclusion Pediatric combined heart-liver transplant is an acceptable option for recipients with combined end-organ failure, with intermediate survival outcomes comparable to those of single-organ recipients with no treated heart or liver rejection reported in the first year. Pediatric combined heart-liver transplantation (cHLTx) remains uncommon in the United States and criteria for cHLTx are unclear. The objective of this study was to review the indications, and outcomes of pediatric cHLTx. Data from the Scientific Registry for Transplant Recipients heart and liver databases were used to identify 9245 pediatric heart transplants (PHTx) alone, 14134 pediatric liver transplant alone, and 20 pediatric cHLTx (16 simultaneous HLTx [same organ donor], + 4 previous heart transplants followed by liver transplant [different organ donors]) (age ≤ 21 years) between 1992 and 2017. Outcomes included patient survival, and 1-year rates of acute heart and liver rejection. The median age for pediatric cHLTx was 15.6 (IQR: 10.5, 17.9) years, and included 12 males (12/20=60%). In the cHLTx group, the most common indication for heart transplant was congenital heart disease (11/20=55%), and the most common indication for liver transplant was cirrhosis (9/20=45%) due to granulomatous diseases including sarcoidosis, histiocytosis or cryptogenic. Recipients of pediatric cHLTx had a similar 5-year adjusted risk of death compared to PHTx alone (p=0.9; Figure 1). The 1, 3, and 5 year actuarial survival rates in pediatric cHLTx recipients was 80%, 80%, and 80% respectively, and was similar to isolated PHTx alone (88%, 82%, and 78% respectively. There was no heart or liver rejection reported in the cHLTx group versus 9.9% in heart only and 10.6% in liver transplant only group, respectively. Pediatric combined heart-liver transplant is an acceptable option for recipients with combined end-organ failure, with intermediate survival outcomes comparable to those of single-organ recipients with no treated heart or liver rejection reported in the first year.