Pediatr Transplant. 2021 Nov;25(7):e14066. doi: 10.1111/petr.14066. Epub 2021 Jun 13.
Pediatric heart-liver transplant outcomes in the United States: A 25-year National Cohort Study.
Pediatric transplantation
Swati Choudhry, William J Dreyer, Kyle D Hope, Yunfei Wang, Joseph A Spinner, Hari P Tunuguntla, Antonio G Cabrera, Jack F Price, Susan W Denfield
Affiliations
Affiliations
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
- Section of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
PMID: 34120386
DOI: 10.1111/petr.14066
Abstract
BACKGROUND: Pediatric HLT remains uncommon in the United States and criteria for HLT are unclear. The objectives of this study were to review the indications, and outcomes of pediatric HLT.
METHODS: Data from the Scientific Registry of Transplant Recipients heart and liver databases were used to identify 9245 pediatric isolated heart transplants (PHT), 14 134 pediatric isolated liver transplant (PLT), and 20 pediatric HLT (16 patients underwent sHLT [same organ donor] and four patients with a history of PHT followed by PLT [different organ donors]; age ≤21 years) between 1992 and 2017. Outcomes included patient survival, and 1-year rates of acute heart and liver rejection.
RESULTS: The median age for pediatric HLT was 15.6 (IQR: 10.5, 17.9) years, and included 12 males (12/20 = 60%). In the HLT group, the most common indication for HT was CHD (12/20 = 60%), and the most common indication for liver transplant was cirrhosis (9/20 = 45%). The 1, 3, and 5 year actuarial survival rates in pediatric simultaneous HLT recipients (n = 16) were 93%, 93%, and 93%, respectively, and was similar to isolated PHT alone (88%, 81%, and 75.5%, respectively and isolated PLT alone (84%, 82%, and 80%), respectively. There was no heart or liver rejection reported in the HLT group versus 9.9% in heart and 10.6% in liver transplant-only groups, respectively.
CONCLUSION: Pediatric HLT is an uncommon but acceptable option for recipients with combined end-organ failure, with intermediate survival outcomes comparable to those of single-organ recipients.
© 2021 Wiley Periodicals LLC.
Keywords: heart transplant; heart-liver transplant; liver transplant
References
- Deo SV, Al-Kindi SG, Altarabsheh SE, et al. Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score predicts heart transplant outcomes: evidence from the registry of the United Network for Organ Sharing. J Heart Lung Transplant. 2016;35:222-227. - PubMed
- van Deursen VM, Damman K, Hillege HL, et al. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail. 2010;16:84-90. - PubMed
- Kim MS, Kato TS, Farr M, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol. 2013;61:2253-2261. - PubMed
- Cannon RM, Hughes MG, Jones CM, Eng M, Marvin MR. A review of the United States experience with combined heart-liver transplantation. Transpl Int. 2012;25:1223-1228. - PubMed
- Barshes NR, Udell IW, Joyce DL, Southard RE, O'Mahony CA, Goss JA. A pooled analysis of posttransplant survival following combined heart-liver transplantation. Transplantation. 2007;83:95-98. - PubMed
- Te HS, Anderson AS, Millis JM, Jeevanandam V, Jensen DM. Current state of combined heart-liver transplantation in the United States. J Heart Lung Transplant. 2008;27:753-759. - PubMed
- Choudhry S, Wang Y, Denfield SW, et al. A recipient risk prediction tool for short-term mortality after pediatric heart transplantation. Transplantation. 2019;103(11):2434-2439. - PubMed
- Lindsay I, Johnson J, Everitt MD, Hoffman J, Yetman AT. Impact of liver disease after the Fontan operation. Am J Cardiol. 2015;115:249-252. - PubMed
- Rychik J, Veldtman G, Rand E, et al. The precarious state of the liver after a Fontan operation: summary of a multidisciplinary symposium. Pediatr Cardiol. 2012;33:1001-1012. - PubMed
- Gewillig M, Goldberg DJ. Failure of the Fontan circulation. Heart Fail Clin. 2014;10:105-116. - PubMed
- Mondésert B, Marcotte F, Mongeon F-P, et al. Fontan circulation: success or failure? Can J Cardiol. 2013;29:811-820. - PubMed
- Hill AL, Maeda K, Bonham CA, Concepcion W. Pediatric combined heart-liver trans- plantation performed en bloc: a single-center experience. Pediatr Transplant. 2012;16:392-397. - PubMed
- Hollander SA, Reinhartz O, Maeda K, Hurwitz M, Rosenthal DN, Bernstein D. Intermediate-term outcomes after combined heart-liver transplantation in children with a univentricular heart. J Heart Lung Transplant. 2013;32:368-370. - PubMed
- Starzl TE, Bahnson HT, Hardesty RL, et al. Heart-liver transplantation in a patient with familial hypercholesterolaemia. Lancet. 1984;1:1382-1383. - PubMed
- Beal EW, Mumtaz K, Hayes D Jr, Whitson BA, Black SM. Combined heart-liver transplantation: indications, outcomes and current experience. Transplant Rev. 2016;30:261-268. - PubMed
- OPTN. Multiple Organ Transplants in the U.S. by Recipient ABO. U.S. Multiple Organ Transplants Performed January 1, 1988 - July 31, 2018. Liver-Heart 2018. https://OPTN.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed August 9, 2018. - PubMed
- Leppke S, Leighton T, Zaun D, et al. Scientific Registry of Transplant Recipients: collecting, analyzing, and reporting data on transplantation in the United States. Transplant Rev. 2013;27:50-56. - PubMed
- Bradley EA, Pinyoluksana KO, Moore-Clingenpeel M, Miao Y, Daniels C. Isolated heart transplant and combined heart-liver transplant in adult congenital heart disease patients: insights from the united network of organ sharing. Int J Cardiol. 2017;228:790-795. - PubMed
- Vallabhajosyula PKC, Molina M, Roche L, Kim Y, Goldberg L, Pochettino A. Combined heart-liver transplantation for failed single ventricle/fontan physiology. J Heart Lung Transplant. 2012;31:S112. - PubMed
- Bryant R, Rizwan R, Zafar F, et al. Contemporary outcomes of combined heart-liver transplant in patients with congenital heart disease. Transplantation. 2018;102(2):e67-e73. - PubMed
- D'Souza BA, Fuller S, Gleason LP, et al. Single-center outcomes of combined heart and liver transplantation in the failing Fontan. Clin Transplant. 2017;31(3):e12892. - PubMed
- Atluri P, Gaffey A, Howard J, et al. Combined heart and liver transplantation can be safely performed with excellent short- and long-term results. Ann Thorac Surg. 2014;98:858-862. - PubMed
- Bernier P-L, Grenon M, Ergina P, et al. Combined simultaneous heart and liver transplantation with complete cardiopulmonary bypass support. Ann Thorac Surg. 2007;83:1544-1545. - PubMed
- Marriott AJ, Hwang NC, Lai FO, et al. Combined heart-liver transplantation with extended cardiopulmonary bypass. Singapore Med J. 2011;52:48-51. - PubMed
- Rana A, Robles S, Russo MJ, et al. The combined organ effect: protection against rejection? Ann Surg. 2008;248:871-879. - PubMed
- Barbara DW, Rehfeldt KH, Heimbach JK, Rosen CB, Daly RC, Findlay JY. The peri-operative management of patients undergoing combined heart-liver transplantation. Transplantation. 2015;99:139-144. - PubMed
- Chou AS, Habertheuer A, Chin AL, et al. Heart-kidney and heart-liver transplantation provide immunoprotection to the cardiac allograft. Ann Thorac Surg. 2019;108(2):458-466. - PubMed
- Vaikunth SS, Concepcion W, Daugherty T, et al. Short-term outcomes of en bloc combined heart and liver transplantation in the failing Fontan. Clin Transplant. 2019;33(6):e13540. - PubMed
- Navaratnam M, Ng A, Williams GD, et al. Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review. Paediatr Anaesth. 2016;26(10):976-986. - PubMed
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