Indications and outcomes of combined heart-liver transplant: A systematic review and met-analysis

• Published in: Transplantation reviews (Philadelphia, Pa.) Pa.), 2020-04, Vol.34 (2), p.100517-100517, Article 100517
• Main Authors: Rizvi, Syed Saif Abbas, Challapalli, Jothika, Maynes, Elizabeth J., Weber, Matthew P., Choi, Jae Hwan, O'Malley, Thomas J., Entwistle, John W., Morris, Rohinton J., Samuels, Louis E., Massey, H. Todd, Tchantchaleishvili, Vakhtang
• Format: Article
• Language: English
• Subjects: Combined heart-liver transplantation; Freedom from rejection; Graft Rejection - immunology; Graft Survival; Heart Failure - complications; Heart Failure - mortality; Heart Failure - therapy; Heart Transplantation; Humans; Liver Failure - complications; Liver Failure - mortality; Liver Failure - therapy; Liver Transplantation; Survival; Survival Analysis; Systematic review; Time Factors; Treatment Outcome
• ISSN: 0955-470X; 1557-9816
• DOI: 10.1016/j.trre.2019.100517

Combined heart-liver transplantation (CHLT) has become a viable option for treating concomitant heart and liver failure. However, data are lacking with respect to long-term outcomes. An electronic search was performed to identify all studies on CHLT. Following application of inclusion and exclusion criteria, a total of seven studies consisting of 99 CHLT patients were included from the original 1864 articles. CHLT recipient mean age was 53.0 years (95% CI 48.0–58.0), 67.5% of which (95% CI 56.5–76.9) were male. 65.5% (95% CI 39.0–85.0) of patients developed heart failure due to amyloidosis whereas 21.6% (95% CI 12.3–35.2) developed heart failure due to congenital causes. The most common indication for liver transplant was amyloidosis [65.5% (95% CI 39.0–85.0)] followed by liver failure due to hepatitis C [13.8% (95% CI 2.1–54.4)]. The mean intensive care unit length of stay was 8 days (95% CI 5–11) with a mean length of stay of 24 days (95% CI 17–31). Cardiac allograft rejection within the first year was 24.7% (95% CI 9.5–50.7), including antibody mediated [5% (95% CI 1.7–15.2)] and T-cell mediated rejection [22.7% (95% CI 8.8–47.1)]. Overall survival was 87.5% (95% CI 78.6–93.0) at 1 year and 84.3% (95% CI 75.4–90.5) at 5 years. CHLT in select patients with coexisting end-stage heart and liver failure appears to offer high survival and low rejection rates. •Combined heart and liver transplant is a viable option for treating combined heart and liver failure•CHLT indications include familial amyloid polyneuropathy (FAP) and familial hypercholesterolemia.•CHLT confers an immuno-protective role which may help reduce acute and chronic allograft rejection.