J Korean Soc Transplant.  2017 Jun;31(2):91-98. 10.4285/jkstn.2017.31.2.91.

Combined Heart and Liver Transplantation: The Asan Medical Center Experience

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jjkim@amc.seoul.kr
  • 2Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Division of Liver Transplantation and Hepato-Biliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

Combined heart-liver transplantation (CHLT) is an increasingly accepted treatment for select patients with advanced heart and liver disease. However, CHLT are infrequently performed, despite growing optimism about their effectiveness. Here, we report Asan Medical Center experience with CHLT in three patients presenting with advanced heart and liver failure. One patient died of brain swelling because of intractable hyperammonemia on postoperative day 9. The two other patients were still alive at 53 and 9 months postsurgery. None of these patients required readmission for cardiac or hepatic graft dysfunction and no rejection episodes were detected on routine cardiac biopsies. This is the first report of CHLT cases from Korea.

Keyword

Heart transplantation; Liver transplantation; Multi-organ transplant; End-stage heart disease

MeSH Terms

Biopsy
Brain Edema
Chungcheongnam-do*
Heart Transplantation
Heart*
Humans
Hyperammonemia
Korea
Liver Diseases
Liver Failure
Liver Transplantation*
Liver*
Optimism
Transplants

Reference

1). Shaw BW Jr., Bahnson HT., Hardesty RL., Griffith BP., Starzl TE. Combined transplantation of the heart and liver. Ann Surg. 1985. 202:667–72.
Article
2). Wallwork J., Williams R., Calne RY. Transplantation of liver, heart, and lungs for primary biliary cirrhosis and primary pulmonary hypertension. Lancet. 1987. 2:182–5.
Article
3). Olivieri NF., Liu PP., Sher GD., Daly PA., Greig PD., McCusker PJ, et al. Brief report: combined liver and heart transplantation for end-stage iron-induced organ failure in an adult with homozygous beta-thalassemia. N Engl J Med. 1994. 330:1125–7.
4). Nardo B., Beltempo P., Bertelli R., Montalti R., Vivarelli M., Cescon M, et al. Combined heart and liver transplantation in four adults with familial amyloidosis: experience of a single center. Transplant Proc. 2004. 36:645–7.
Article
5). Barbir M., Khaghani A., Kehely A., Tan KC., Mitchell A., Thompson GR, et al. Normal levels of lipoproteins including lipoprotein(a) after liver-heart transplantation in a patient with homozygous familial hypercholesterolaemia. Q J Med. 1992. 85:807–12.
6). Bahnson HT., Gordon RD. Transplantation of other organs with the heart. Cardiovasc Clin. 1990. 20:237–48.
7). U.S. Department of Health and Human Services, Health Resources and Services Administration. Organ procurement and transplantation network: data [Internet]. Richmond: HRSA;2017. [cited 2017 Jun 8]. Available from:. http://optn.transplant.hrsa.gov/data/.
8). Huffman C., Wagman G., Fudim M., Zolty R., Vittorio T. Reversible cardiomyopathies: a review. Transplant Proc. 2010. 42:3673–8.
9). Raichlin E., Daly RC., Rosen CB., McGregor CG., Charlton MR., Frantz RP, et al. Combined heart and liver transplantation: a single-center experience. Transplantation. 2009. 88:219–25.
Article
10). Atluri P., Gaffey A., Howard J., Phillips E., Goldstone AB., Hornsby N, et al. Combined heart and liver transplantation can be safely performed with excellent short- and long-term results. Ann Thorac Surg. 2014. 98:858–62.
Article
11). Reich HJ., Awad M., Ruzza A., De Robertis MA., Ramzy D., Nissen N, et al. Combined heart and liver transplantation: the Cedars-Sinai experience. Transplant Proc. 2015. 47:2722–6.
Article
12). Nagpal AD., Chamogeorgakis T., Shafii AE., Hanna M., Miller CM., Fung J, et al. Combined heart and liver transplantation: the Cleveland Clinic experience. Ann Thorac Surg. 2013. 95:179–82.
Article
13). Schaffer JM., Chiu P., Singh SK., Oyer PE., Reitz BA., Mallidi HR. Combined heart-liver transplantation in the MELD era: do waitlisted patients require exception status? Am J Transplant. 2014. 14:647–59.
Article
14). Te HS., Anderson AS., Millis JM., Jeevanandam V., Jensen DM. Current state of combined heart-liver transplantation in the United States. J Heart Lung Transplant. 2008. 27:753–9.
Article
15). Cannon RM., Hughes MG., Jones CM., Eng M., Marvin MR. A review of the United States experience with combined heart-liver transplantation. Transpl Int. 2012. 25:1223–8.
Article
16). Korean Network for Organ Sharing (KONOS). 2016 Quarterly data [Internet]. Seoul: KONOS;c2014. [cited 2017 Jun 8]. Available from:. https://www.konos.go.kr.
17). Barshes NR., Udell IW., Joyce DL., Southard RE., O'Mahony CA., Goss JA. A pooled analysis of posttransplant survival following combined heart-liver transplantation. Transplantation. 2007. 83:95–8.
Article
18). Barbara DW., Rehfeldt KH., Heimbach JK., Rosen CB., Daly RC., Findlay JY. The perioperative management of patients undergoing combined heart-liver transplantation. Transplantation. 2015. 99:139–44.
Article
19). Costanzo MR., Dipchand A., Starling R., Anderson A., Chan M., Desai S, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010. 29:914–56.
20). Daly RC., Topilsky Y., Joyce L., Hasin T., Gandhi M., Rosen C, et al. Combined heart and liver transplantation: protection of the cardiac graft from antibody rejection by initial liver implantation. Transplantation. 2013. 95:e2–4.
21). Rana A., Robles S., Russo MJ., Halazun KJ., Woodland DC., Witkowski P, et al. The combined organ effect: protection against rejection? Ann Surg. 2008. 248:871–9.
22). Topilsky Y., Raichlin E., Hasin T., Boilson BA., Schirger JA., Pereira NL, et al. Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplantation. Transplantation. 2013. 95:859–65.
Article
Full Text Links
  • JKSTN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr