Differences in outcomes of combined heart-liver transplantation by primary cardiac diagnosis
Ye In Christopher Kwon, BA,
Emily Dunbar, MD,
Kelly Wright, BS,
Graham Gardner, MD,
Matthew Ambrosio, MS,
Inna F. Tchoukina, MD,
Keyur B. Shah, MD,
David Bruno, MD,
Amit Sharma, MD,
Josue Chery, MD,
Vigneshwar Kasirajan, MD,
Zubair A. Hashmi, MD
Affiliations
Ye In Christopher Kwon, BA
School of Medicine, Virginia Commonwealth University, Richmond, Virginia; Corresponding author: Ye In Christopher Kwon, BA, School of Medicine, Virginia Commonwealth University, 1201 E. Marshall St., Richmond, VA 23298.
Emily Dunbar, MD
School of Medicine, Virginia Commonwealth University, Richmond, Virginia
Kelly Wright, BS
School of Medicine, Virginia Commonwealth University, Richmond, Virginia
Graham Gardner, MD
Division of General Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
Matthew Ambrosio, MS
Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, Virginia
Inna F. Tchoukina, MD
Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
Keyur B. Shah, MD
Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
David Bruno, MD
Division of Abdominal Transplant Surgery, Department of Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, Virginia
Amit Sharma, MD
Division of Abdominal Transplant Surgery, Department of Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, Virginia
Josue Chery, MD
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
Vigneshwar Kasirajan, MD
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
Zubair A. Hashmi, MD
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
Background: Combined heart-liver transplantation (CHLT) is a complex procedure with rising demand and is subject to ongoing assessment. Here, we provide an update on indications, patient outcomes, and risk factors. Methods: This retrospective study utilized CHLT data from the United Network for Organ Sharing registry between 1990 and 2023. Recipient and donor characteristics, and risk factors for mortality were analyzed using Cox regression hazard models. Recipient and graft survival at 30 days, 1 year, and 5 years were analyzed using the Kaplan-Meier method. Results: This cohort included 532 patients with median survival of 16.9 years (SD: 1.09). The most common indications for CHLT were congenital heart disease (36%) and dilated cardiomyopathy (31%). Patient survival at 30 days, 1 year, and 5 years were 94%, 85%, and 77%, respectively. Combined heart-liver graft survival was 93%, 85%, and 77%, respectively. Diabetes (hazard ratio [HR]: 1.74; p = 0.04) was associated with multigraft failure and mortality in multivariate analysis. Compared to congenital heart disease, dilated (HR: 0.55; p = 0.03) and restrictive myopathies (HR: 0.5; p = 0.03) were associated with improved graft and overall survival. Higher donor left ventricular ejection fraction (EF) was also associated with improved graft and overall survival (HR: 0.96; p = 0.008). Conclusions: CHLTs are being performed at increasingly higher rates with comparable survival to single-organ transplants. Diabetes was associated with increased mortality. Recipient dilated or restrictive myopathies and higher donor EF were correlated with improved survival compared to congenital heart disease. Further studies are needed to better understand these observations.
