Successful long-term outcomes in combined heart-liver transplants across pre-formed high levels of donor-specific antibodies in highly sensitized patients

Padegimas, Allison; Molina, María; Korwin, Amy; Birati, Edo Y.; Kamoun, Malek

doi:10.1016/j.healun.2016.09.012

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…Surveillance biopsies were performed in 96.9% of CHLT patients and 95.3% of HA patients. The median number of biopsies performed in the first year was significantly higher in HA patients than in CHLT patients (15 [IQR, [13][14][15][16] vs. 13 [IQR,[11][12][13][14][15]; p < 0.01). Average tacrolimus levels at the time of all available myocardial biopsies were not significantly different between CHLT and HA patients (9.6 ug/L ± 2.5 vs. 10.3 ug/L ± 1.7; p = 0.14).…”

Section: Cell-mediated Rejectionmentioning

confidence: 99%

“…In three cases of CHLT, desensitization was performed with a combination of rituximab, plasmapheresis, intravenous immunoglobulin, and thymoglobulin. [12] Patients were screened for the presence of de novo anti-HLA DSAs at 1, 3, 6, 12, 24, and 36 months after transplantation. Additional for-cause samples were included when available.…”

Section: Cohortsmentioning

confidence: 99%

“…Pretransplant serum creatinine values were similar (CHLT 1.3 mg/dl [IQR, 1.1-1.5 mg/dl] vs. HA 1.2 mg/ dl [IQR, 1.0-1.5 mg/dl]; p = 0.34). CHLT patients had a median Model for End-Stage Liver Disease (MELD) score of 16 (IQR,[11][12][13][14][15][16][17][18][19][20] and median bilirubin of 1.0 mg/dl (IQR, 0.8-1.8 mg/dl).…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Incidence of acute rejection and patient survival in combined heart–liver transplantation

Zhao

Wang

Kamoun

et al. 2022

Liver Transplantation

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Combined heart–liver transplantation (CHLT) is indicated for patients with concomitant end‐stage heart and liver disease or patients with amyloid heart disease where liver transplantation mitigates progression. Limited data suggest that the liver allograft provides immunoprotection for heart and kidney allografts in combined transplantation from the same donor. We hypothesized that CHLT reduces the incidence of acute cellular rejection (ACR) and the development of de novo donor‐specific antibodies (DSAs) compared with heart‐alone transplantation (HA). We conducted a retrospective analysis of 32 CHLT and 280 HA recipients in a single‐center experience. The primary outcome was incidence of ACR based on protocol and for‐cause myocardial biopsy. Rejection was graded by the International Society of Heart and Lung Transplantation guidelines with Grade 2R and higher considered significant. Secondary outcomes included the development of new DSAs, cardiac function, and patient and cardiac graft survival rates. Of CHLT patients, 9.7% had ACR compared with 45.3% of HA patients (p < 0.01). Mean pretransplant calculated panel reactive antibody (cPRA) levels were similar between groups (CHLT 9.4% vs. HA 9.5%; p = 0.97). Among patients who underwent testing, 26.9% of the CHLT and 16.7% of HA developed DSA (p = 0.19). Despite the difference in ACR, patient and cardiac graft survival rates were similar at 5 years (CHLT 82.1% vs. HA 80.9% [p = 0.73]; CHLT 82.1% vs. HA 80.9% [p = 0.73]). CHLT reduced the incidence of ACR in the cardiac allograft, suggesting that the liver offers immunoprotection against cellular mechanisms of rejection without significant impacts on patient and cardiac graft survival rates. CHLT did not reduce the incidence of de novo DSA, possibly portending similar long‐term survival among cardiac allografts in CHLT and HA.

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Section: Cell-mediated Rejectionmentioning

confidence: 99%

Section: Cohortsmentioning

confidence: 99%

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Incidence of acute rejection and patient survival in combined heart–liver transplantation

Zhao

Wang

Kamoun

et al. 2022

Liver Transplantation

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“…Liver allografts have long been observed to be more “tolerant” to HLA mismatch and alloimmune injuries. In addition, liver allografts demonstrate some degree of immune protection in combined organ transplants . CHLT recipients usually do not receive induction therapy.…”

Section: Postoperative Immunosuppressionmentioning

confidence: 99%

Combined Heart and Liver Transplant: Indication, Patient Selection, and Allocation Policy

Zhao

McLean

Hoteit

et al. 2019

Clinical Liver Disease

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“…Since the first CHLT in 1984, the procedure has gained widespread acceptance in the medical community, with 38 US medical centers performing CHLT as of 2015, with regions 2 and 5 being responsible for 41% of all CHLT performed 2,3. Survival of CHLT is reported to be comparable to heart transplantation (HT) alone, with recent data pointing toward the liver’s immunoprotective effect on the heart 4–6…”

Section: Introductionmentioning

confidence: 99%

Combined heart-liver transplantation practices survey in North America: Evaluation and organ listing practices

Shingina

Chadha

Lim

et al. 2023

Liver Transplantation

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We conducted a web-based survey to characterize liver transplant (LT) evaluation and listing practices for patients being evaluated for combined heart-liver transplantation (CHLT), with a specific emphasis on patients with congenital heart disease (CHD), around transplant centers in North America. Very few protocols for liver evaluation and listing in patients undergoing combined heart-liver transplantation are published, and no guidelines currently exist on this topic. A subject of intense debate in the transplant community is the decision of which patients with CHD and liver disease benefit from CHLT compared with heart transplantation. A focus group from the American Society of Transplantation Liver-Intestine Community of Practice Education Subcommittee developed a web-based survey that included questions (1) respondee demographic information; (2) LT evaluation practices in CHLT; (3) liver organ listing practices in CHLT, and (4) 4 clinical vignettes with case-based scenarios in CHLT liver listings among CHD patients who underwent Fontan palliation. The survey was distributed to medical and surgical LT program directors of 47 centers that had completed at least 1 CHLT up to July 2021 in the US and the University of Toronto, Canada. The survey had an excellent 83% response rate (87% for centers that completed at least 1 CHLT in the past 5 y). Total 66.7% used transjugular liver biopsy with HVPG measurements, 30% used percutaneous liver biopsy with no consensus on the use of a fibrosis staging system, 95% mandated contrasted cross-sectional imaging, and 65% upper endoscopy. The following isolated findings evaluation mandated CHLT listing: isolated elevated HVPG (61.5%); the presence of portosystemic collaterals on imaging (67.5%); the endoscopic presence of esophageal or gastric varices (75%), and the presence of HCC (80%), whereas the majority of centers did not feel that the presence of isolated splenomegaly (100%), thrombocytopenia (81.6%), endoscopic findings of portal hypertensive gastropathy (66.7%), or highly sensitized patients (84.6%) justified CHLT. In our survey of North American centers that had performed at least 1 CHLT in the past 5 years, we observed heterogeneity in practices for both evaluation and listing protocols in these patients.

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Successful long-term outcomes in combined heart-liver transplants across pre-formed high levels of donor-specific antibodies in highly sensitized patients

Cited by 9 publications

References 5 publications

Incidence of acute rejection and patient survival in combined heart–liver transplantation

Incidence of acute rejection and patient survival in combined heart–liver transplantation

Combined Heart and Liver Transplant: Indication, Patient Selection, and Allocation Policy

Combined heart-liver transplantation practices survey in North America: Evaluation and organ listing practices

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