Combined heart and liver transplantation on cardiopulmonary bypass: report of four cases

Hennessey, Trevor; Backman, Steven B.; Cecere, Renzo; Lachapelle, Kevin; Varennes, Benoit de; Ergina, Patrick; Metrakos, Peter; Schricker, Thomas

doi:10.1007/s12630-010-9263-y

Cited by 29 publications

(15 citation statements)

References 24 publications

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“…These patients should be thoroughly evaluated, as we have described, and would benefit from referral to higher volume transplantation centers with experience in caring for such patients. As noted in our report, and by Joshi et al, there have been case reports of successful transplantation in such patients, often requiring combined liver and heart transplantation (2). Several potential etiologies of systolic dysfunction in patients with end-stage liver disease have been described, and some may be reversible (3,4).…”

Section: Replysupporting

confidence: 63%

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Harinstein¹,

Raval²,

Gheorghiade³

et al. 2011

Journal of the American College of Cardiology

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Section: Replysupporting

confidence: 63%

Reply

Harinstein¹,

Raval²,

Gheorghiade³

et al. 2011

Journal of the American College of Cardiology

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“…Thus, the presence of pre-operative left ventricular dysfunction is not an absolute contraindication to LT, but is a risk factor for perioperative cardiovascular complications. Successful LT in patients with ejection fraction as low as 10% has been reported with aggressive medical management (64). Volume status and symptoms of heart failure should be monitored and optimized before transplantations.…”

Section: Pre-operative Cardiovascular Assessment and Managementmentioning

confidence: 99%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

228

174

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Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.

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“…Although it is no longer the standard of practice to complete the entire procedure on CPB, experts report that while there are risks to CPB [39] during liver transplantation these are outweighed by the improved hemodynamic stability and decreased metabolic disturbances with hepatic reperfusion, protecting the cardiac allograft from hyperkalemia, fluid overload and acidosis, thereby lessening stress on the newly implanted cardiac graft [36–38]. The combined procedure on CPB also reduces liver cold ischemia time by eliminating the time period required for reversal of anticoagulation [36,38].…”

Section: Order Of Operation Cardiopulmonary Bypass and Venovenousmentioning

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 on cardiopulmonary bypass: report of four cases

Abstract: Combined heart and liver transplant during cardiopulmonary bypass is a viable strategy that may confer benefit to this unique type of patient.

Cited by 29 publications

References 24 publications

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Cardiovascular Risk Assessment of the Liver Transplant Candidate

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

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