Korean J Transplant.  2022 Nov;36(Supple 1):S249. 10.4285/ATW2022.F-3888.

Successful simultaneous heart-liver-kidney transplantation with excellent long-term outcomes: first in Asia

• Mahawithitwong P
• Chirakarnjanakorn S
• Sirivatanauksorn Y
• Sakiyalak P
• Taweemonkongsap T
• Jitpraphai S
• Kositamongkol P
• Nitiyarom E
• Tovikkai C

• KMID: 2535466
• DOI: http://doi.org/10.4285/ATW2022.F-3888

Abstract

Simultaneous heart-liver-kidney (HLK) transplantation is a super-complex surgery that is an effective treatment for end-stage disease of multiple organs. There have been only 25 HLK transplants reported worldwide, and none were from Asian countries. Herein, we reported our experience in successful simultaneous HLK transplantation in Thailand. A 27-year-old male, who was diagnosed with IgM nephropathy and on dialysis, later developed uremic dilated cardiomyopathy and cardiac cirrhosis. His condition gradually worsened with NYHA class III, refractory ascites, and intradialytic hypotension. Simultaneous three-organ transplantation was decided by the multidisciplinary transplant team according to the end-stage disease of the three organs. He underwent combined simultaneous HLK from a 15-year-old traffic-related brain death donor in December 2017. Induction therapy was initiated with total plasma exchange. After the recipient's heart was prepared for removal, liver was dissected be-fore cardiopulmonary bypass (CPB) was initiated to prevent bleeding after heparinization. Intravenous immunoglobulin, thymo-globulin, and methylprednisolone were given later intraoperatively after CPB was initiated. After completion of cardiac grafting and heart beating, orthotopic liver transplantation was performed while on CPB. CPB was weaned off before kidney transplan-tation was finally performed. The total operative time was 12 hours and 5 minutes. Cardiac and liver function was stabilized, while kidney had delayed graft function and hemodialysis was needed for 2 more months. He was discharged on postoperative day 83 without any organ support. At 56-month posttransplant, all allografts have normal function without graft rejection. The patient can return to work with good quality of life. Regarding immunosuppression, he is currently on tacrolimus, everolimus, and prednisolone. We reported our experience in successful simultaneous HLK transplantation for the treatment of dilated car-diomyopathy, liver cirrhosis, and end-stage renal disease with excellent long-term outcomes. To our knowledge, this is the first case report of simultaneous HLK transplantation in Asia.