title: Combined Heart and Liver Transplantation: The Cedars-Sinai Experience.
abstract: OBJECTIVE
  Combined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation.
  
  
  METHODS
  All combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998-2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission.
  
  
  RESULTS
  There were 7 heart-liver transplants: 6 simultaneous (single donor) and 1 staged (2 donors). Median follow-up was 22.1 (IQR 13.2-48.4) months. Mean recipient age was 50.8 ± 19.5 years. Heart failure etiologies included familial amyloidosis, congenital heart disease, hypertrophic cardiomyopathy, systemic lupus erythematosus, and dilated cardiomyopathy. Preoperative left ventricular ejection fraction averaged 32.3 ± 12.9%. Five (71.4%) patients required preoperative inotropic support; 1 required mechanical circulatory support. The most common indications for liver transplant were amyloidosis and cardiac cirrhosis. Median Model for End-stage Liver Disease score was 10.0 (9.3-13.8). Six-month and 1-year actuarial survivals were 100% and 83.3%, with mean survival exceeding 4 years. No patient experienced cardiac allograft rejection, 1 experienced transient liver allograft rejection, and 1 developed progressive liver dysfunction resulting in death. Five developed postoperative infections and 3 (42.9%) required reoperation. Median ICU and hospital stays were 7.0 (7.0-11.5) and 17.0 (13.8-40.5) days. There were 4 (57.1%) readmissions.
  
  
  CONCLUSIONS
  For carefully selected patients with coexisting heart and liver disease, combined heart and liver transplantation offers acceptable patient and graft survival.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: H J
authors.initials: HJ
authors.lastname: Reich
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: M
authors.initials: M
authors.lastname: Awad
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: A
authors.initials: A
authors.lastname: Ruzza
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: M A
authors.initials: MA
authors.lastname: De Robertis
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: D
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: N
authors.initials: N
authors.lastname: Nissen
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: S
authors.initials: S
authors.lastname: Colquhoun
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: F
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States. Electronic address: Lawrence.Czer@cshs.org.
authors.forename: L S
authors.initials: LS
authors.lastname: Czer
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome