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. 2022 Jan 4:35:10036.
doi: 10.3389/ti.2021.10036. eCollection 2021.

Adult Combined Heart-Liver Transplantation: The United States Experience

Sophoclis P Alexopoulos  1 , W Kelly Wu  1 , Ioannis A Ziogas  1 , Lea K Matsuoka  1 , Muhammad A Rauf  1 , Manhal Izzy  2 , Roman Perri  2 , Kelly H Schlendorf  3 , Jonathan N Menachem  3 , Ashish S Shah  4
Affiliations

Adult Combined Heart-Liver Transplantation: The United States Experience

Sophoclis P Alexopoulos et al. Transpl Int. .

Abstract

Background: We aimed to review the indications and outcomes of adults undergoing combined heart-liver transplantation (CHLT) in the US using national registry data. Methods: 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. 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). 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). Conclusion: CHLT is being increasingly performed with evolving indications. Excellent outcomes can be achieved with multidisciplinary patient and donor selection and surgical planning.

Keywords: United Network for Organ Sharing; combined heart-liver transplantation; heart transplantation; liver transplantation; patient survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Bar plot demonstrating an increase in the number of patients receiving combined heart-liver transplantation by transplant year.
FIGURE 2
FIGURE 2
(A) Kaplan-Meier patient survival curve for the total cohort of combined heart-liver transplant recipients. (B) Kaplan-Meier patient survival curves demonstrating differences by transplant era.
FIGURE 3
FIGURE 3
Kaplan-Meier patient survival curves demonstrating no statistically significant difference by cardiac diagnosis.
See this image and copyright information in PMC

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