En-Bloc Simultaneous Heart-Liver Transplantation in Adult Patients

Nicolas A. Brozzi, Matthias Loebe, Fouad Ghazi Souki, Thiago Beduschi, Ali Ghodzisad, Akin Tekin, Ramona Nicolau-Raducu, Rodrigo M. Vianna

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Complexity of combined heart-liver transplantation has resulted in low adoption rates. We report a case series of adult patients receiving en-bloc heart-liver transplantation (HLTx), describe technical aspects, and discuss benefits of the technique. Methods: Retrospective review of patients receiving en-bloc HLTx over 18 months, with clinical follow up to 1 year. Primary outcomes included postoperative mortality and major complications. Secondary outcomes included 1-year survival, cardiac or hepatic allograft rejection, and infection. Results: Five patients received en-bloc HLTx. Mean recipient age was 43 years (26-63), and 3 patients were male. Total operative time was 430 minutes (393-480), cold and warm ischemic times of 85 (32-136) and 37.5 (31-47) minutes. Hospital survival was 80%. One patient died on postoperative day 55 due to fungal sepsis. Major postoperative complications included prolonged mechanical ventilation in 2 of 5 patients (40%), and renal insufficiency requiring hemodialysis in 2 of 5 patients (40%). Among patients discharged from hospital 1-year survival was 100%, with no evidence of rejection or infectious complications. Conclusion: En-bloc HLTx technique is a safe and effective strategy, decreasing operative times, and allograft ischemic times, whereas offering protection of implanted allografts during early stages of reperfusion while patient is hemodynamically supported on cardiopulmonary bypass.


  • Combined heart-liver transplant
  • En-bloc heart-liver transplant

ASJC Scopus subject areas

  • Surgery


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