title: Combined heart and liver transplantation: a single-center experience.
abstract: BACKGROUND
  Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx.
  
  
  METHODS
  Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1).
  
  
  RESULTS
  Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT > or =grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6+/-53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity.
  
  
  CONCLUSIONS
  Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.
authors.affiliation: William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA. eraichlin@unmc.edu
authors.forename: Eugenia
authors.initials: E
authors.lastname: Raichlin
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Christopher G
authors.initials: CG
authors.lastname: McGregor
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Clavell
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous / Q000502:physiology; D016896:Treatment Outcome