The perioperative management of patients undergoing combined heart-liver transplantation

David W. Barbara, Kent H. Rehfeldt, Julie K. Heimbach, Charles B. Rosen, Richard C. Daly, James Y. Findlay

Research output: Contribution to journalArticle

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Abstract

Background. Combined heart-liver transplantation (CHLT) is an uncommonly performed procedure for patients with coexisting cardiac and liver disease.

Methods. A retrospective review was performed of patients undergoing CHLT at our institution from 1999 to 2013. Information related to preoperative organ function, intraoperative management, surgical approach, transfusions, postoperative findings, and 30-day mortality was reviewed.

Results. Twenty-seven CHLT were performed, with 4 of the 27 including simultaneous kidney transplantation. Familial amyloidosis was the indication for 21 CHLTs (78%), and 12 of these explanted livers were used for domino transplantations. Nineteen patients (70%) were receiving inotropic infusions at the time of organ availability. Median preoperative model for end-stage liver disease score was 12. Liver transplantation immediately preceded cardiac transplantation in 2 of the 27 cases because of the presence of high titer donor-specific antibodies and the potential of the liver to lead to a reduction in the antibody titer. Venovenous bypass was used in 14 operations (52%) which were performed with the caval interposition approach to liver transplantation, cardiopulmonary bypass during liver transplantation in two cases (7%), and no bypass in 11 operations (41%) performed with caval sparing (piggyback) surgical technique. Postoperatively, median duration of mechanical ventilation, intensive care unit stay, and hospital stay until discharge were 1 day, 5.5 days, and 15 days, respectively. Transfusions in the first 48 hr after CHLT were not substantial in most patients. One patient died within 30 days of CHLT.

Conclusion. Combined heart-liver transplantation is a life-saving operation that is performed with relatively low mortality and can be successfully performed in select patients with congenital or acquired cardiac disease.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalTransplantation
Volume99
Issue number1
DOIs
StatePublished - Jan 15 2015

Fingerprint

Heart Transplantation
Liver Transplantation
Venae Cavae
Heart Diseases
Familial Amyloidosis
End Stage Liver Disease
Mortality
Antibodies
Liver
Cardiopulmonary Bypass
Artificial Respiration
Kidney Transplantation
Intensive Care Units
Liver Diseases
Length of Stay
Transplantation
Tissue Donors

ASJC Scopus subject areas

  • Medicine(all)
  • Transplantation

Cite this

Barbara, D. W., Rehfeldt, K. H., Heimbach, J. K., Rosen, C. B., Daly, R. C., & Findlay, J. Y. (2015). The perioperative management of patients undergoing combined heart-liver transplantation. Transplantation, 99(1), 139-144. https://doi.org/10.1097/TP.0000000000000231

The perioperative management of patients undergoing combined heart-liver transplantation. / Barbara, David W.; Rehfeldt, Kent H.; Heimbach, Julie K.; Rosen, Charles B.; Daly, Richard C.; Findlay, James Y.

In: Transplantation, Vol. 99, No. 1, 15.01.2015, p. 139-144.

Research output: Contribution to journalArticle

Barbara, DW, Rehfeldt, KH, Heimbach, JK, Rosen, CB, Daly, RC & Findlay, JY 2015, 'The perioperative management of patients undergoing combined heart-liver transplantation', Transplantation, vol. 99, no. 1, pp. 139-144. https://doi.org/10.1097/TP.0000000000000231
Barbara DW, Rehfeldt KH, Heimbach JK, Rosen CB, Daly RC, Findlay JY. The perioperative management of patients undergoing combined heart-liver transplantation. Transplantation. 2015 Jan 15;99(1):139-144. https://doi.org/10.1097/TP.0000000000000231
Barbara, David W. ; Rehfeldt, Kent H. ; Heimbach, Julie K. ; Rosen, Charles B. ; Daly, Richard C. ; Findlay, James Y. / The perioperative management of patients undergoing combined heart-liver transplantation. In: Transplantation. 2015 ; Vol. 99, No. 1. pp. 139-144.
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abstract = "Background. Combined heart-liver transplantation (CHLT) is an uncommonly performed procedure for patients with coexisting cardiac and liver disease.Methods. A retrospective review was performed of patients undergoing CHLT at our institution from 1999 to 2013. Information related to preoperative organ function, intraoperative management, surgical approach, transfusions, postoperative findings, and 30-day mortality was reviewed.Results. Twenty-seven CHLT were performed, with 4 of the 27 including simultaneous kidney transplantation. Familial amyloidosis was the indication for 21 CHLTs (78{\%}), and 12 of these explanted livers were used for domino transplantations. Nineteen patients (70{\%}) were receiving inotropic infusions at the time of organ availability. Median preoperative model for end-stage liver disease score was 12. Liver transplantation immediately preceded cardiac transplantation in 2 of the 27 cases because of the presence of high titer donor-specific antibodies and the potential of the liver to lead to a reduction in the antibody titer. Venovenous bypass was used in 14 operations (52{\%}) which were performed with the caval interposition approach to liver transplantation, cardiopulmonary bypass during liver transplantation in two cases (7{\%}), and no bypass in 11 operations (41{\%}) performed with caval sparing (piggyback) surgical technique. Postoperatively, median duration of mechanical ventilation, intensive care unit stay, and hospital stay until discharge were 1 day, 5.5 days, and 15 days, respectively. Transfusions in the first 48 hr after CHLT were not substantial in most patients. One patient died within 30 days of CHLT.Conclusion. Combined heart-liver transplantation is a life-saving operation that is performed with relatively low mortality and can be successfully performed in select patients with congenital or acquired cardiac disease.",
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N2 - Background. Combined heart-liver transplantation (CHLT) is an uncommonly performed procedure for patients with coexisting cardiac and liver disease.Methods. A retrospective review was performed of patients undergoing CHLT at our institution from 1999 to 2013. Information related to preoperative organ function, intraoperative management, surgical approach, transfusions, postoperative findings, and 30-day mortality was reviewed.Results. Twenty-seven CHLT were performed, with 4 of the 27 including simultaneous kidney transplantation. Familial amyloidosis was the indication for 21 CHLTs (78%), and 12 of these explanted livers were used for domino transplantations. Nineteen patients (70%) were receiving inotropic infusions at the time of organ availability. Median preoperative model for end-stage liver disease score was 12. Liver transplantation immediately preceded cardiac transplantation in 2 of the 27 cases because of the presence of high titer donor-specific antibodies and the potential of the liver to lead to a reduction in the antibody titer. Venovenous bypass was used in 14 operations (52%) which were performed with the caval interposition approach to liver transplantation, cardiopulmonary bypass during liver transplantation in two cases (7%), and no bypass in 11 operations (41%) performed with caval sparing (piggyback) surgical technique. Postoperatively, median duration of mechanical ventilation, intensive care unit stay, and hospital stay until discharge were 1 day, 5.5 days, and 15 days, respectively. Transfusions in the first 48 hr after CHLT were not substantial in most patients. One patient died within 30 days of CHLT.Conclusion. Combined heart-liver transplantation is a life-saving operation that is performed with relatively low mortality and can be successfully performed in select patients with congenital or acquired cardiac disease.

AB - Background. Combined heart-liver transplantation (CHLT) is an uncommonly performed procedure for patients with coexisting cardiac and liver disease.Methods. A retrospective review was performed of patients undergoing CHLT at our institution from 1999 to 2013. Information related to preoperative organ function, intraoperative management, surgical approach, transfusions, postoperative findings, and 30-day mortality was reviewed.Results. Twenty-seven CHLT were performed, with 4 of the 27 including simultaneous kidney transplantation. Familial amyloidosis was the indication for 21 CHLTs (78%), and 12 of these explanted livers were used for domino transplantations. Nineteen patients (70%) were receiving inotropic infusions at the time of organ availability. Median preoperative model for end-stage liver disease score was 12. Liver transplantation immediately preceded cardiac transplantation in 2 of the 27 cases because of the presence of high titer donor-specific antibodies and the potential of the liver to lead to a reduction in the antibody titer. Venovenous bypass was used in 14 operations (52%) which were performed with the caval interposition approach to liver transplantation, cardiopulmonary bypass during liver transplantation in two cases (7%), and no bypass in 11 operations (41%) performed with caval sparing (piggyback) surgical technique. Postoperatively, median duration of mechanical ventilation, intensive care unit stay, and hospital stay until discharge were 1 day, 5.5 days, and 15 days, respectively. Transfusions in the first 48 hr after CHLT were not substantial in most patients. One patient died within 30 days of CHLT.Conclusion. Combined heart-liver transplantation is a life-saving operation that is performed with relatively low mortality and can be successfully performed in select patients with congenital or acquired cardiac disease.

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