Roosevelt Bryant1,2, Raheel Rizwan1,2, Farhan Zafar1,2, Shimul A Shah3, Clifford Chin2,4, James S Tweddell1,2, David L Morales1,2. 1. Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 2. University of Cincinnati College of Medicine, Cincinnati, OH. 3. Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH. 4. Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Abstract
BACKGROUND: As more patients survive into adulthood with repaired congenital heart disease (CHD), transplant centers now have patients presenting with both end-stage cardiac and hepatic failure. An understanding of the contemporary outcomes with combined heart liver transplantation (CHLT) in patients with CHD is needed. METHODS: A retrospective review of the outcomes of CHLT in CHD was conducted from October 1, 1987, to June 30, 2015, from the United Network of Organ Sharing (UNOS) database. Propensity score matched cohorts were formed for the assessment of posttransplant outcome: CHLT with CHD, CHLT without CHD, and isolated heart transplant for CHD (HT-CHD). Cohorts were matched based on age, body mass index, inotrope use, and ventilator support at the time of transplant. We assessed 30-day, 1-, 5-, and 10-year posttransplant survivals. RESULTS: There were 61 437 heart transplants during the study period, of which 190 (0.3%) were CHLT. Among CHLT, 41(22%) patients had CHD. In 26 (63%) of these, the indication for CHLT was hepatic congestion/cirrhosis of cardiac origin. In the matched cohorts, the overall survival for CHLT with CHD at 30 days, 1, 5, and 10 years was 95%, 86%, 83%, and 83%, respectively; for CHLT without CHD, it was 100%, 92%, 92%, and 63%, respectively (vs CHLT with CHD: P = 0.49); and for HT-CHD, it was 90%, 84%, 63%, and 39% (vs CHLT with CHD: P = 0.03), respectively. CONCLUSIONS: The posttransplant outcome of CHLT, with and without CHD, is comparable. However, there is a trend toward better survival for CHLT for CHD compared with isolated heart transplant for CHD.
BACKGROUND: As more patients survive into adulthood with repaired congenital heart disease (CHD), transplant centers now have patients presenting with both end-stage cardiac and hepatic failure. An understanding of the contemporary outcomes with combined heart liver transplantation (CHLT) in patients with CHD is needed. METHODS: A retrospective review of the outcomes of CHLT in CHD was conducted from October 1, 1987, to June 30, 2015, from the United Network of Organ Sharing (UNOS) database. Propensity score matched cohorts were formed for the assessment of posttransplant outcome: CHLT with CHD, CHLT without CHD, and isolated heart transplant for CHD (HT-CHD). Cohorts were matched based on age, body mass index, inotrope use, and ventilator support at the time of transplant. We assessed 30-day, 1-, 5-, and 10-year posttransplant survivals. RESULTS: There were 61 437 heart transplants during the study period, of which 190 (0.3%) were CHLT. Among CHLT, 41(22%) patients had CHD. In 26 (63%) of these, the indication for CHLT was hepatic congestion/cirrhosis of cardiac origin. In the matched cohorts, the overall survival for CHLT with CHD at 30 days, 1, 5, and 10 years was 95%, 86%, 83%, and 83%, respectively; for CHLT without CHD, it was 100%, 92%, 92%, and 63%, respectively (vs CHLT with CHD: P = 0.49); and for HT-CHD, it was 90%, 84%, 63%, and 39% (vs CHLT with CHD: P = 0.03), respectively. CONCLUSIONS: The posttransplant outcome of CHLT, with and without CHD, is comparable. However, there is a trend toward better survival for CHLT for CHD compared with isolated heart transplant for CHD.
Authors: José Ignacio Fortea; Ángela Puente; Antonio Cuadrado; Patricia Huelin; Raúl Pellón; Francisco José González Sánchez; Marta Mayorga; María Luisa Cagigal; Inés García Carrera; Marina Cobreros; Javier Crespo; Emilio Fábrega Journal: Int J Mol Sci Date: 2020-12-10 Impact factor: 5.923
Authors: Sophoclis P Alexopoulos; W Kelly Wu; Ioannis A Ziogas; Lea K Matsuoka; Muhammad A Rauf; Manhal Izzy; Roman Perri; Kelly H Schlendorf; Jonathan N Menachem; Ashish S Shah Journal: Transpl Int Date: 2022-01-04 Impact factor: 3.782