Combined Heart and Liver Transplantation Can Be Safely Performed With Excellent Short- and Long-Term Results

Atluri, Pavan; Gaffey, Ann C.; Howard, Jessica; Phillips, Emily C.; Goldstone, Andrew B.; Hornsby, Nicole; MacArthur, John W.; Cohen, Jeffrey Е.; Gutsche, Jacob T.; Woo, Y. Joseph

doi:10.1016/j.athoracsur.2014.04.100

Cited by 79 publications

(63 citation statements)

References 22 publications

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“…129 Familial amyloidosis is a rare entity, whereas biventricular failure among patients with HF is becoming increasingly common. 130 The ensuing elevations in central venous pressure can have a profound impact on liver function, resulting in bridging fibrosis and cirrhosis.…”

Section: Role Of Combined Heart Liver Transplantationmentioning

confidence: 99%

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

VanWagner

Harinstein

Runo

et al. 2018

American Journal of Transplantation

116

181

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Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis, thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. Therefore, this review, assembled by a group of multidisciplinary experts in the field and endorsed by the American Society of Transplantation Liver and Intestine and Thoracic and Critical Care Communities of Practice, provides a critical assessment of the diagnosis of cardiac and pulmonary vascular disease and interventions aimed at managing these conditions in LT candidates. Key points and practice-based recommendations for the diagnosis and management of cardiac and pulmonary vascular disease in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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Section: Role Of Combined Heart Liver Transplantationmentioning

confidence: 99%

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

VanWagner

Harinstein

Runo

et al. 2018

American Journal of Transplantation

116

181

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“…Programs should be encouraged to implement quality initiatives in which contemporary laboratory and imaging data, including transient elastography, are prospectively collected and combined with clinical information to target high-risk patients for biopsy (Figure 1). Alternative options are available for those found to have advanced liver disease, as defined by Farr et al 13 Recent single-center 23 and registry 24 data suggest that combined heart and liver transplantation is highly feasible and associated with excellent short-term and long-term survival (up to 87% at 1 year and 83% at 5 years). In addition, similar to findings in combined heart-kidney transplant, less rejection 23 and early attenuation of cardiac allograft vasculopathy 25 have been observed.…”

Section: Figurementioning

confidence: 98%

Assessing the liver to predict outcomes in heart transplantation

Givertz

2015

The Journal of Heart and Lung Transplantation

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“…The chest was then closed over two chest tubes [15]. The majority of authors used this technique or a slightly modified version [Table 4] [7,9,10,12,16,21,29,31–35]. …”

Section: Order Of Operation Cardiopulmonary Bypass and Venovenousmentioning

confidence: 99%

“…In a large single-center series, a lower than anticipated rate of rejection, which they state may be caused by hepatic allograft conferring a protective effect on the cardiac allograft [31]. In a single center study the rate of acute rejection was found to be lower in patients who have received a combined heart and liver transplantation than in those who have received an isolated liver transplant or isolated heart transplant and report that the incidence of acute liver rejection in patients with liver graft survival greater than 1 year was lower in the CHLT group than in those undergoing liver transplant alone (5.2% versus 12.2%, p = 0.060) [5].…”

Section: Graft Tolerancementioning

confidence: 99%

Combined heart–liver transplantation: Indications, outcomes and current experience

Beal

Mumtaz

Hayes

et al. 2016

Transplantation Reviews

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Combined heart–liver transplantation is a rare, life-saving procedure that treats complex and often fatal diseases including familial amyloidosis polyneuropathy and late stage congenital heart disease status-post previous repair. There were 159 combined heart–liver transplantations performed between January 1, 1988 and October 3, 2014 in the United States. A multitude of potential techniques to be used for combined heart and liver transplant including: orthotopic heart transplant (OHT) and orthotopic liver transplant (OLT) on full cardiopulmonary bypass (CPB), OHT with CPB and OLT with venovenous bypass (VVB), OHT with CPB and OLT without VVB, enbloc technique and sequential transplantation. Outcomes of combined heart–liver transplant have been demonstrated to be comparable to outcomes of isolated heart and isolated liver transplant. The liver graft may provide some tolerance of other allografts © 2016 Elsevier Inc. All rights reserved.

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Combined Heart and Liver Transplantation Can Be Safely Performed With Excellent Short- and Long-Term Results

Cited by 79 publications

References 22 publications

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

Assessing the liver to predict outcomes in heart transplantation

Combined heart–liver transplantation: Indications, outcomes and current experience

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