Indications and outcomes of combined heart-liver transplant: A systematic review and met-analysis

Syed Saif Abbas Rizvi, Jothika Challapalli, Elizabeth J. Maynes, Matthew P. Weber, Jae Hwan Choi, Thomas J. O'Malley, John W. Entwistle, Rohinton J. Morris, Louis E. Samuels, H. Todd Massey, Vakhtang Tchantchaleishvili*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Background: Combined heart-liver transplantation (CHLT) has become a viable option for treating concomitant heart and liver failure. However, data are lacking with respect to long-term outcomes. Methods: An electronic search was performed to identify all studies on CHLT. Following application of inclusion and exclusion criteria, a total of seven studies consisting of 99 CHLT patients were included from the original 1864 articles. Results: CHLT recipient mean age was 53.0 years (95% CI 48.0–58.0), 67.5% of which (95% CI 56.5–76.9) were male. 65.5% (95% CI 39.0–85.0) of patients developed heart failure due to amyloidosis whereas 21.6% (95% CI 12.3–35.2) developed heart failure due to congenital causes. The most common indication for liver transplant was amyloidosis [65.5% (95% CI 39.0–85.0)] followed by liver failure due to hepatitis C [13.8% (95% CI 2.1–54.4)]. The mean intensive care unit length of stay was 8 days (95% CI 5–11) with a mean length of stay of 24 days (95% CI 17–31). Cardiac allograft rejection within the first year was 24.7% (95% CI 9.5–50.7), including antibody mediated [5% (95% CI 1.7–15.2)] and T-cell mediated rejection [22.7% (95% CI 8.8–47.1)]. Overall survival was 87.5% (95% CI 78.6–93.0) at 1 year and 84.3% (95% CI 75.4–90.5) at 5 years. Conclusions: CHLT in select patients with coexisting end-stage heart and liver failure appears to offer high survival and low rejection rates.

Original languageEnglish
Article number100517
JournalTransplantation Reviews
Issue number2
StatePublished - Apr 2020
Externally publishedYes


  • Combined heart-liver transplantation
  • Freedom from rejection
  • Survival
  • Systematic review


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