Combined Heart and Liver Transplantation: The Cedars-Sinai Experience

• The frequency of combined heart-liver transplants performed is small but on the rise and patient and graft outcomes are not well-established.
• At our institution, 6-month and 1-year actuarial survival rates were 100% and 83.3%, with mean survival exceeding 4 years.
• The liver graft may protect the cardiac graft from rejection: no clinically significant episodes of cardiac rejection occurred in our cohort.

PurposeCombined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation.MethodsAll combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998–2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission.ResultsThere were 7 heart-liver transplants: 6 simultaneous (single donor) and 1 staged (2 donors). Median follow-up was 22.1 (IQR 13.2–48.4) months. Mean recipient age was 50.8 ± 19.5 years. Heart failure etiologies included familial amyloidosis, congenital heart disease, hypertrophic cardiomyopathy, systemic lupus erythematosus, and dilated cardiomyopathy. Preoperative left ventricular ejection fraction averaged 32.3 ± 12.9%. Five (71.4%) patients required preoperative inotropic support; 1 required mechanical circulatory support. The most common indications for liver transplant were amyloidosis and cardiac cirrhosis. Median Model for End-stage Liver Disease score was 10.0 (9.3–13.8). Six-month and 1-year actuarial survivals were 100% and 83.3%, with mean survival exceeding 4 years. No patient experienced cardiac allograft rejection, 1 experienced transient liver allograft rejection, and 1 developed progressive liver dysfunction resulting in death. Five developed postoperative infections and 3 (42.9%) required reoperation. Median ICU and hospital stays were 7.0 (7.0–11.5) and 17.0 (13.8–40.5) days. There were 4 (57.1%) readmissions.ConclusionsFor carefully selected patients with coexisting heart and liver disease, combined heart and liver transplantation offers acceptable patient and graft survival.