title: Combined heart-liver transplantation: a single-center experience.
abstract: Combined orthotopic heart and liver transplantation (CHLT) is a lifesaving procedure for patients with end-stage heart-liver disease. We reviewed the long-term outcome of patients who have undergone CHLT at the University of Bologna, Italy. Fifteen patients with heart and liver failure were placed on the transplant list between November 1999 and March 2012. The pretransplant cardiac diagnoses were familial amyloidosis in 14 patients and chronic heart failure due to chemotherapy with liver failure due to chronic hepatitis in one patient. CHLT was performed as a single combined procedure in 14 hemodynamically stable patients; there was no peri-operative mortality. The survival rates for the CHLT recipients were 93%, 93%, and 82% at 1 month and 1 and 5 years, respectively. Freedom from graft rejection was 100%, 90%, and 36% at 1, 5, and 10 years, respectively, for the heart graft and 100%, 91%, and 86% for the liver graft. The livers of eight recipients were transplanted as a "domino" with mean overall 1-year survival of 93%. Simultaneous heart and liver transplantation is feasible and was achieved in this extremely sick cohort of patients. By adopting the domino technique, we were able to enlarge the donor cohort and include high-risk patients.
authors.affiliation: Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Careddu
authors.affiliation: Multiorgan Transplantation Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zanfi
authors.affiliation: Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pantaleo
authors.affiliation: Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Anotonio
authors.initials: A
authors.lastname: Loforte
authors.affiliation: Multiorgan Transplantation Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Multiorgan Transplantation Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Regional Transplant Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Alvaro
authors.affiliation: Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pilato
authors.affiliation: Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
authors.affiliation: Multiorgan Transplantation Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
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; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome
keywords: combined heart-liver transplant; domino transplant; multi-organ transplant