TY - JOUR
T1 - Indications and outcomes of combined heart-liver transplant
T2 - A systematic review and met-analysis
AU - Rizvi, Syed Saif Abbas
AU - Challapalli, Jothika
AU - Maynes, Elizabeth J.
AU - Weber, Matthew P.
AU - Choi, Jae Hwan
AU - O'Malley, Thomas J.
AU - Entwistle, John W.
AU - Morris, Rohinton J.
AU - Samuels, Louis E.
AU - Massey, H. Todd
AU - Tchantchaleishvili, Vakhtang
N1 - Publisher Copyright:
© 2019
PY - 2020/4
Y1 - 2020/4
N2 - 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.
AB - 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.
KW - Combined heart-liver transplantation
KW - Freedom from rejection
KW - Survival
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85076536791&partnerID=8YFLogxK
U2 - 10.1016/j.trre.2019.100517
DO - 10.1016/j.trre.2019.100517
M3 - Review article
C2 - 31831325
AN - SCOPUS:85076536791
SN - 0955-470X
VL - 34
JO - Transplantation Reviews
JF - Transplantation Reviews
IS - 2
M1 - 100517
ER -