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=<p><bold>Background:</bold> We aimed to review the indications and outcomes of adults undergoing combined heart-liver transplantation (CHLT) in the US using national registry data.</p><p><bold>Methods:</bold> Adult (≥18 years) CHLT recipients in the United Network for Organ Sharing database were included (09/1987–09/2020; 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.</p><p><bold>Results:</bold> We identified 369 adults receiving CHLT between 12/1989–08/2020. The number of adult CHLT recipients (R<sup>2</sup> = 0.75, <italic>p</italic> &lt; 0.001) and centers performing CHLT (R<sup>2</sup> = 0.80, <italic>p</italic> &lt; 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 (<italic>p</italic> = 0.03). The 1-, 3-, and 5-years 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).</p><p><bold>Conclusion:</bold> CHLT is being increasingly performed with evolving indications. Excellent outcomes can be achieved with multidisciplinary patient and donor selection and surgical planning.</p>