INNOVATIONS IN HEART TRANSPLANTATION I

Y. Toyoda¹, C. Bermudez¹, R. Kormos¹, J. Bhama¹, J. Thacker¹, T. Horai¹, B. Sareyyupoglu¹, P. Bonde¹, A. Bansal¹, N. Shigemura¹, A. Humar², P. Fontes^3
1Cardiothoracic Transplantation, University of Pittsburgh, Pittsburgh/PA/UNITED STATES OF AMERICA, ²Surgery / Transplant, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, ³Transplant Surgery, Thomas E. Starzl Transplantation Institute, PITTSBURGH/PA/UNITED STATES OF AMERICA

Body: Introduction: Congenital heart disease is well known to be a risk factor for poor outcome following adult heart transplantation, and end-stage liver disease is considered a contraindication for heart transplantation. Therefore, heart transplant candidates due to congenital heart diseases together with end-stage liver disease are considered extremely high risk and these patients are declined for transplantation in most centers. The purpose of this study was to show our experience of simultaneous heart-liver transplant for patients with congenital heart disease and end-stage liver cirrhosis.
Methods: Of more than 1200 adult heart transplants performed at our institution since 1968, three patients with congenital heart disease underwent a simultaneous heart-liver transplant. Retrospective analysis was performed using prospectively collected transplant data base.

Results: Cardiac diagnosis included s/p Mustard procedure for transposition of the great arteries, s/p ASD closure and Uhl’s disease, and s/p Fontan procedure for situs ambiguous, dextrocardia, single ventricle, inferior vena cava interruption, left superior vena cava with hemi-azygos connection. Hepatic diagnoses were congestive liver cirrhosis and one superimposed hepatitis C infection. The recipient age was 36±8 (21-50) years. All patients had thrombocytopenia and Child A or B liver cirrhosis. Two patients had greater than 10% PRA preoperatively. The donor age was 34±10 (23-53) years. The cardiac ischemic and cardiopulmonary bypass time was 154±63 (73-280) and 202±22 (159-231) minutes. No primary graft failure requiring mechanical circulatory support was observed. The duration of mechanical ventilation was 6±3 days. No patients required hemodialysis postoperatively, but Cr peaked at 2.5+/-0.8 which was increased from 1.0+/-0.1 preoperatively. The hospital stay was 41±8 (26-55) days. All three patients are surviving in NYHA class I with mean and median follow-up period of 1231 and 1117 days, respectively. No patient has developed grade 2 or greater rejection out of 49 myocardial biopsies.

Conclusions: Simultaneous heart-liver transplant can be successfully performed for patients with congenital heart disease with meticulous surgery. No significant rejection was observed, suggesting immune-protective effects of simultaneous liver transplantation.

Disclosure: All authors have declared no conflicts of interest.