title: Combined heart and liver transplantation: the Cleveland Clinic experience.
abstract: BACKGROUND
  Combined heart-liver transplantation (CHLT) has been utilized as a life-saving procedure in those with end-stage cardiac and hepatic pathology. Techniques and outcomes of this procedure are varied. We sought to review the Cleveland Clinic experience with CHLT.
  
  
  METHODS
  This study is a retrospective chart review of patients who received simultaneous heart and liver transplantation between January 2006 and December 2012.
  
  
  RESULTS
  Five patients received CHLT. The mean age was 49 (± 20) years. All cardiac pathology was nonischemic cardiomyopathy, with a mean ejection fraction of 0.36 (± 0.13). Three of the 5 were on preoperative inotropic support, 1 of which required placement of a total artificial heart for support pretransplant. Liver pathology was amyloid in 1 patient and hepatitis C in the remaining 4. Mean Model for End-Stage Liver Disease score was 17 (± 5), and mean Childs-Pugh score was 8 (± 1). Survival, now at a mean of 38 (± 20) months remains 100%, with no cardiac or hepatic graft dysfunction or episodes of rejection. One hospital readmission was required for gastroenteritis at 15 months posttransplant.
  
  
  CONCLUSIONS
  These results suggest that excellent outcomes can be achieved in this extremely sick cohort of patients, and add to the growing literature of perioperative management of CHLT recipients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: A Dave
authors.initials: AD
authors.lastname: Nagpal
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Shafii
authors.forename: Mazen
authors.initials: M
authors.lastname: Hanna
authors.forename: Charles M
authors.initials: CM
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
mesh_terms: D000293:Adolescent; D000328:Adult; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult