Outcomes in Combined Heart-Liver Transplantation: A Single-Center Experience

Abstract

Purpose Combined heart and liver transplantation is an uncommon operation. Given the rarity of this procedure, outcomes data have been limited to case reports and several single-institution series. To better define this patient population and augment the existing data, we report our combined heart and liver transplant experience. Methods An institutional database was queried to identify all patients undergoing combined heart-liver transplantation between 1998 and 2018. A retrospective review of baseline patient characteristics and outcomes was performed. Results Sixteen patients (age 51.4 ± 16, male 69%) underwent combined heart-liver transplantation between 1998 and 2018. The majority (81.3%) of patients were afflicted with non-ischemic cardiomyopathies (idiopathic: 25.0%, congenital: 18.8%, infectious: 12.5%, restrictive: 12.5%, autoimmune: 6.5%), while only 18.8% of patients presented with ischemic cardiomyopathy. Median ejection fraction was 20% [18.3-37.3], and mechanical assist devices or intra-aortic balloon pumps were employed in 25.0% and 18.8%, respectively. Concurrent with cardiac pathology, patients presented with cardiac cirrhosis (43.8%), hepatitis C cirrhosis (25%), primary biliary cirrhosis (6.3%), NASH (6.3%), autoimmune (6.3%) and amyloid (6.3%) liver disease. The median MELD score was 17.5 [12.0-21.3], and 62.5% of patients exhibited ascites. Patients underwent simultaneous transplantation, with median cardiac and hepatic graft ischemia times of 189.0 min and 486.5 min, respectively. Mild cardiac rejection (ACR 1R, AMR 1, DSA:DQ8) occurred in 18.8%, while hepatic rejection occurred in 12.5% of patients. Median intensive care unit and total hospital length of stay were 7.0 [5.0-9.0] and 65.5 [40.8-97.8] days, respectively. In hospital mortality occurred in one patient, with 30-day and 1-year survival rates of 93.8% and 92.8%, respectively. Conclusion This single institution experience with combined heart-liver transplantation augments the available data for this rare procedure, and demonstrates that it can be performed with excellent outcomes.