title: Successful combined liver-heart transplantation in adults: report of three patients and review of the literature.
abstract: BACKGROUND
  Three patients received liver/heart transplantation, and we report their successful outcome.
  
  
  METHODS
  Two patients had alcoholic cirrhosis and dilated cardiomyopathy; one had cryptogenic liver disease and idiopathic cardiomyopathy.
  
  
  RESULTS
  All patients had evidence of portal hypertension and coagulopathy. The cardiac transplants were performed first. Cardiopulmonary bypass was discontinued in favor of venovenous bypass, and liver transplantation was then performed. All patients developed acute tubular necrosis; two required a brief period of hemodialysis. There was only one episode of acute cellular rejection of the liver. Protocol endomyocardial biopsies in all three patients revealed no evidence of rejection. All patients are currently using low doses of immunosuppressive medications and have normal liver chemistry tests and cardiac function; two patients have mild renal insufficiency.
  
  
  CONCLUSIONS
  In selected patients with severe cardiac dysfunction and advanced liver disease, liver/heart transplantation can be successfully performed even in the face of portal hypertension and coagulopathy.
authors.affiliation: GI Division/Liver Study Unit, University of Chicago Hospitals, Illinois 60438, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Befeler
authors.forename: T D
authors.initials: TD
authors.lastname: Schiano
authors.forename: T W
authors.initials: TW
authors.lastname: Lissoos
authors.forename: H S
authors.initials: HS
authors.lastname: Conjeevaram
authors.forename: A S
authors.initials: AS
authors.lastname: Anderson
authors.forename: J M
authors.initials: JM
authors.lastname: Millis
authors.forename: M
authors.initials: M
authors.lastname: Albertucci
authors.forename: A L
authors.initials: AL
authors.lastname: Baker
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged