To the Editor

Abstract

I read with interest the recent review on combined heart and liver transplantation by Smeltz et al.1Smeltz AM Kumar PA Arora H. Anesthesia for combined heart and liver transplantation.J Cardiovasc Vasc Anesth. 2021; 35: 3350-3361Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The authors referenced Navaratman et al,2Navaratnam M Ng A Williams GD et al.Perioperative management of pediatric en-bloc combined heart-liver transplants: A case series review.Paediatr Anaesth. 2016; 26: 976-986Crossref PubMed Scopus (17) Google Scholar who described a series of 5 pediatric cases in which en bloc combined heart and liver transplant was performed in 1 institution over an 8-year period. They also cited Brozzi et al, who reported 5 cases in adults.3Brozzi NA Loebe M Souki FG et al.En-bloc simultaneous heart-liver transplantation in adult patients.Ann Surg. 2021; 274: e1284-e1289Crossref PubMed Scopus (3) Google Scholar However, the authors did not provide any data about the sequential technique (transplanting the liver with the newly transplanted heart beating while on cardiopulmonary bypass), although this approach may confer significant benefits for the transplanted heart. Indeed, our group published a case series of 4 combined heart and liver transplants using this sequential approach with good long-term outcomes.4Hennessey T Backman SB Cecere R et al.Combined heart and liver transplantation on cardiopulmonary bypass: Report of four cases.Can J Anesth. 2010; 57: 355-360Crossref PubMed Scopus (26) Google Scholar I read with interest the recent review on combined heart and liver transplantation by Smeltz et al.1Smeltz AM Kumar PA Arora H. Anesthesia for combined heart and liver transplantation.J Cardiovasc Vasc Anesth. 2021; 35: 3350-3361Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The authors referenced Navaratman et al,2Navaratnam M Ng A Williams GD et al.Perioperative management of pediatric en-bloc combined heart-liver transplants: A case series review.Paediatr Anaesth. 2016; 26: 976-986Crossref PubMed Scopus (17) Google Scholar who described a series of 5 pediatric cases in which en bloc combined heart and liver transplant was performed in 1 institution over an 8-year period. They also cited Brozzi et al, who reported 5 cases in adults.3Brozzi NA Loebe M Souki FG et al.En-bloc simultaneous heart-liver transplantation in adult patients.Ann Surg. 2021; 274: e1284-e1289Crossref PubMed Scopus (3) Google Scholar However, the authors did not provide any data about the sequential technique (transplanting the liver with the newly transplanted heart beating while on cardiopulmonary bypass), although this approach may confer significant benefits for the transplanted heart. Indeed, our group published a case series of 4 combined heart and liver transplants using this sequential approach with good long-term outcomes.4Hennessey T Backman SB Cecere R et al.Combined heart and liver transplantation on cardiopulmonary bypass: Report of four cases.Can J Anesth. 2010; 57: 355-360Crossref PubMed Scopus (26) Google Scholar None. Anesthesia for Combined Heart and Liver TransplantationJournal of Cardiothoracic and Vascular AnesthesiaVol. 35Issue 11PreviewA 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, nationwide experience is relatively limited at most institutions. The aim of this review is to discuss the perioperative challenges presented to the anesthesiology teams and provide evidence-based guidance for the management of these daunting procedures. Full-Text PDF