Pediatric Combined Heart-liver Transplantation: A Single-center Long-term Experience

Steven Levitte, MD, PhD; Riya Nilkant; Sharon Chen, MD; Angela Beadles, PharmD; Joanne Lee, PharmD; Clark A. Bonham, MD; David Rosenthal, MD; Amy Gallo, MD; Seth Hollander, MD; Carlos Esquivel, MD; Michael Ma, MD; Ke-You Zhang, MD

doi:10.1097/TXD.0000000000001696

Transplantation Direct (Sep 2024)

Pediatric Combined Heart-liver Transplantation: A Single-center Long-term Experience

Steven Levitte, MD, PhD,
Riya Nilkant,
Sharon Chen, MD,
Angela Beadles, PharmD,
Joanne Lee, PharmD,
Clark A. Bonham, MD,
David Rosenthal, MD,
Amy Gallo, MD,
Seth Hollander, MD,
Carlos Esquivel, MD,
Michael Ma, MD,
Ke-You Zhang, MD

Affiliations

Steven Levitte, MD, PhD: 1 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA.
Riya Nilkant: 2 Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA.
Sharon Chen, MD: 3 Division of Pediatric Cardiology, Stanford University, Palo Alto, CA.
Angela Beadles, PharmD: 4 Department of Pharmacy, Lucile Packard Children’s Hospital, Palo Alto, CA.
Joanne Lee, PharmD: 4 Department of Pharmacy, Lucile Packard Children’s Hospital, Palo Alto, CA.
Clark A. Bonham, MD: 5 Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, CA.
David Rosenthal, MD: 3 Division of Pediatric Cardiology, Stanford University, Palo Alto, CA.
Amy Gallo, MD: 5 Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, CA.
Seth Hollander, MD: 3 Division of Pediatric Cardiology, Stanford University, Palo Alto, CA.
Carlos Esquivel, MD: 5 Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, CA.
Michael Ma, MD: 2 Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA.
Ke-You Zhang, MD: 1 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA.

DOI: https://doi.org/10.1097/TXD.0000000000001696
Journal volume & issue: Vol. 10, no. 9
p. e1696

Abstract

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Background. Combined heart liver transplant (CHLT) continues to gain attention as a surgical treatment for patients with end-stage heart and liver disease but remains rare. We present our institutional longitudinal experience with up to 14 y of follow-up, focused on long-term outcomes in CHLT recipients. Methods. We conducted a single-institutional, retrospective review from January 1, 2010, to December 31, 2023, including 7 patients ages 7–17 y who underwent CHLT. Results. Most patients were surgically palliated via Fontan procedure pretransplant (n = 6), and all had evidence of advanced fibrosis or cirrhosis before transplant. The 30-d mortality was 14.3% (n = 1, multiorgan failure). During the follow-up period, 1 patient developed acute heart rejection which required treatment and 2 developed acute liver rejection. In all cases, rejection was successfully treated. Two patients developed acute heart rejection which did not require treatment (grade 1R). No patients developed chronic or refractory rejection. No patients developed allograft coronary artery vasculopathy. Conclusions. CHLT remains a rarely performed treatment for pediatric patients with end-stage heart and liver disease, but our long-term data suggest that this treatment strategy should be considered more frequently.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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