Current state of combined heart-liver transplantation in the United States

Abstract

Background: Combined heart-liver transplantation (CHLT) has been increasingly performed in the USA, but published data on overall patient and graft outcomes have been limited.

Methods: This study aimed to review the indications, immunosuppression, complications and outcomes of CHLT in the USA. From October 1987 to December 2005, a total of 47 cases of combined heart-liver (n = 41) and heart-liver-kidney transplantation (n = 6) were reported to the United Network for Sharing (UNOS) database. One pediatric case was excluded from the analysis. The mean age of recipients was 46 years (range, 22 to 65 years) and included 31 (67%) men and 16 (33%) women.

Results: The most common indication for both heart and liver transplantation was amyloidosis (30%). Patients were followed for a mean duration of 1,362 days or 3.7 years (range, 1 to 4,598 days or 0 to 12.6 years). Patient, heart and liver graft survival rates were 84.8%, 84.8% and 82.4% at 1 year, and 75.6%, 75.6% and 73.5% at 5 years, respectively. At the latest follow-up of patients who survived at least 6 months after transplantation (n = 39), 28.2% of patients were on a single immunosuppressive agent.

Conclusions: Combined heart-liver transplantation is a viable option for candidates who require the combined transplantation, with outcomes comparable to those of single-organ recipients.