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

Abstract

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.

Keywords

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

ASJC Scopus subject areas

  • Surgery

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