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. 2025 Aug;39(8):e70277.
doi: 10.1111/ctr.70277.

Combined Heart and Liver Transplantation: A Single Center Experience and Review of National Data

Amen Z Kiani  1 , Jessica Lindemann  1 , Neeta Vachharajani  1 , Angela L Hill  1 , Diego F Chaparro  1 , Sakil S Kulkarni  2 , Janis Stoll  2 , Sarah A F Henkel  2 , Pirooz Eghtesady  3 , Dilip Nath  3 , Jacob R Miller  3 , William C Chapman  1 , Majella B Doyle  1 , Adeel S Khan  1
Affiliations

Combined Heart and Liver Transplantation: A Single Center Experience and Review of National Data

Amen Z Kiani et al. Clin Transplant. 2025 Aug.

Abstract

Background: Combined heart-liver transplantation (CHLT) is a high-risk procedure that is infrequently performed in select patients with end-stage heart and liver disease. This study details a single center experience with simultaneous (en bloc or sequential) CHLT.

Methods: This is a single center retrospective review of 12 simultaneous CHLT performed over a 12-year period. Studied variables included basic clinical data, intraoperative and postoperative details, and outcomes. A comparison of our outcomes to the national cohort was also performed using the UNOS registry.

Results: Twelve CHLTs (five pediatric, seven adult) were performed between 2011 and 2023. Mean age was 32 years (range 7-62 years, 75% male). Congenital heart disease with cardiac cirrhosis (58%) and amyloidosis (25%) were the most common indications. Liver and heart wait list times were 125 and 116 days, respectively. The majority of CHLTs were performed en-bloc (n = 8; 67%) and four (33%) were performed sequentially (liver following heart). Mean post-operative ICU and total length of stay (LOS) were 16 and 28 days, respectively, with six patients requiring unplanned return to OR (three for hemoperitoneum, three for hemopericardium). There were no intraoperative deaths, and one patient died on POD 1 from hyperacute rejection. None of the patients required re-transplant after a median follow-up of 37.5 months. Both overall and graft survival for the cohort at 1-, 3-, and 5-years remained 92%.

Conclusion: CHLT remains the only viable option for carefully selected patients with end-stage heart and liver failure and is associated with excellent patient outcomes.

Keywords: combined; heart transplant; liver transplant; national data; review.

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References

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