Premium
Liver Allograft Provides Immunoprotection for the Cardiac Allograft in Combined Heart–Liver Transplantation
Author(s) -
Wong T. W.,
Gandhi M. J.,
Daly R. C.,
Kushwaha S. S.,
Pereira N. L.,
Rosen C. B.,
Stegall M. D.,
Heimbach J. K.,
Taner T.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13870
Subject(s) - medicine , liver transplantation , immunosuppression , heart transplantation , ejection fraction , transplantation , gastroenterology , odds ratio , incidence (geometry) , cardiology , surgery , urology , heart failure , physics , optics
When transplanted simultaneously, the liver allograft has been thought to have an immunoprotective role on other organs; however, detailed analyses in simultaneous heart–liver transplantation ( SHLT ) have not been done to date. We analyzed patient outcomes and incidence of immune‐mediated injury in 22 consecutive SHLT versus 223 isolated heart transplantation ( IHT ) recipients between January 2004 and December 2013, by reviewing 3912 protocol‐ and indication‐specific cardiac allograft biopsy specimens. Overall survival was similar (86.4%, 86.4%, and 69.1% for SHLT and 93.3%, 84.7%, and 70.0% for IHT at 1, 5, and 10 years; p = 0.83). Despite similar immunosuppression, the incidence of T cell–mediated rejection ( TCMR ) was lower in SHLT (31.8%) than in IHT (84.8%) (p < 0.0001). Although more SHLT patients had preexisting donor‐specific HLA antibody (22.7% versus 8.1%; p = 0.04), the incidence of antibody‐mediated rejection was not different in SHLT compared with IHT (4.5% versus 14.8%, p = 0.33). While the left ventricular ejection fraction was comparable in both groups at 5 years, the incidence and severity of cardiac allograft vasculopathy were reduced in the SHLT recipients (42.9% versus 66.8%, p = 0.03). Simultaneously transplanted liver allograft was associated with reduced risk of TCMR (odds ratio [ OR] 0.003, 95% confidence interval [ CI] 0–0.02; p < 0.0001), antibody‐mediated rejection ( OR 0.04, 95% CI 0–0.46; p = 0.004), and cardiac allograft vasculopathy ( OR 0.26, 95% CI 0.07–0.84; p = 0.02), after adjusting for other risk factors. These data suggest that the incidence of alloimmune injury in the heart allograft is reduced in SHLT recipients.