Outcomes of Combined Heart-Liver Transplant: A Systematic Review

Abstract

Purpose In patients with liver failure who have coexisting heart failure, combined heart-liver transplantation (CHLT) can be performed. Outcomes in terms of survival and freedom from rejection remain largely unknown due to lack of sufficient data. The goal of this study was to pool the existing literature for evaluating outcomes after CHLT. Methods An electronic search was performed to identify all studies on CHLT in the English literature. All identified articles were systematically assessed for inclusion and exclusion criteria. Of 1864 articles identified, a total of seven studies were pooled for final analysis. Results A total of 99 patients who underwent CHLT between 1997 to 2014 were included in the analysis. The mean age of CHLT recipients was 52 years (95% CI 40.8 - 57.96) and 67.5% (95% CI 56.5 - 76.9) of patients were male. Amyloidosis was the most common indication for both the heart [65.5% (95% CI 39.0 - 85.0)] and the liver transplant [65.5% (95% CI 39.0 - 85.0)]. Mean follow up period was 31.4 months (95% CI 14.66 - 48.14). Total cardiac allograft rejection within the first year was 24.7% (95% CI 9.5 - 50.7), including antibody mediated [5% (95% CI 1.7 - 15.2)] and T-cell mediated rejection [22.7% (95% CI 8.8 - 47.1)]. Freedom from rejection at five years was 81.8% (95% CI 69.2 - 89.9). Survival after CHLT was 93.3% (95% CI 84.2 - 97.3) at 6 months, 87.5% (95% CI 78.6 - 93.0) at 1 year and 84.3% (95% CI 75.4 - 90.5) at 5 years (Figure). Conclusion CHLT in selected patients with coexisting end-stage heart and liver disease can be a viable treatment option and with acceptable survival and freedom from rejection.