AUTHOR=Alexopoulos Sophoclis P. , Wu W. Kelly , Ziogas Ioannis A. , Matsuoka Lea K. , Rauf Muhammad A. , Izzy Manhal , Perri Roman , Schlendorf Kelly H. , Menachem Jonathan N. , Shah Ashish S. 

TITLE=Adult Combined Heart-Liver Transplantation: The United States Experience

JOURNAL=Transplant International

VOLUME=Volume 35 - 2021

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2021.10036

DOI=10.3389/ti.2021.10036

ISSN=1432-2277

ABSTRACT=Background: Combined heart-liver transplantation (CHLT) is utilized with increased frequency in the United States to treat dual organ failure with improved outcomes. We aimed to review the indications and outcomes of adults undergoing CHLT using national registry data.
Methods: Adult (≥18 years) CHLT recipients in the United Network for Organ Sharing database were included (09/1987-09/2020). Transplant era was grouped as: era 1=1989-2000, era 2=2001-2010, era 3=2011-2020. Survival analysis was conducted by means of Kaplan-Meier method, log-rank test, and Cox regression.
Results: We identified 369 adults receiving CHLT between 12/1989-08/2020. The number of adult CHLT recipients (R2=0.75, P<0.001) and centers performing CHLT (R2=0.80, P<0.001) have increased over the study period. The most common cardiac diagnosis in the first two eras was restrictive/infiltrative cardiomyopathy, while the most common in era 3 was congenital heart disease (P=0.03). During eras 1 and 2, nearly all CHLTs were sequential-heart first (100% and 97.1%, respectively), while in era 3, 79.9% were sequential-heart first, 13.8% sequential-liver first, and 6.3% simultaneous (P=0.001). The 1-, 3-, and 5-year patient survival was 86.8%, 80.1%, and 77.9%, respectively. In multivariable analysis, recipient diabetes (adjusted hazard ratio [aHR]=2.35, 95%CI:1.23-4.48), CHLT between 1989-2000 compared with 2011-2020 (aHR=5.00, 95%CI:1.13-22.26), and sequential-liver first CHLT compared with sequential-heart first CHLT (aHR=2.44, 95%CI:1.15-5.18) were associated with increased risk of mortality. Higher left ventricular ejection fraction was associated with decreased risk of mortality (aHR=0.96, 95%CI:0.92-0.99).
Conclusions: CHLT is being increasingly performed with evolving indications. Excellent outcomes can be achieved with multidisciplinary patient and donor selection and surgical planning.